bluuebunny/crossref_metadata_2025 huggingface dataset:
Institutional Reform and the Reorganization of Family Support Services
Authors: Blackler Frank , Regan Suzanne
Published: October 2006

Accounts of institutional change developed from structuration theory (Barley and Tolbert, 1997; Greenwood et al., 2002) are compared with an account developed from Foucauldian theory (Hasselbladh and Kallinikos, 2000). They are considered in the context of a project that was intended to pioneer a new, integrated approach to child and family support services in a deprived area in the North of England. It was undertaken at a time when the British government was pursuing an ambitious programme of reform across the public sector. The project challenged entrenched practices in the statutory agencies (social services, health, education and the police) and also those within independent, voluntary organizations providing services to children and families in the area. None of the theories of institutional change considered here anticipated the muddles, misunderstandings, false starts and loose ends that were a feature of the case. While both structuration theory and Foucauldian theory stress the significance of the internalization of new ideas, problems in this case developed because of the difficulties participants had in externalizing new approaches into new practices. This overlooked aspect of institutional change is conceptualized as a ‘contested ascent’ from the abstract to the concrete.
Mathematical Model of Pneumatic Artificial Muscle Reinforced by Straight Fibers
Authors: Saga Norihiko , Nakamura Taro , Yaegashi Kenji
Published: October 2006

This article describes a mathematical model of a pneumatic artificial muscle reinforced by straight fibers. The pneumatic artificial muscle is lightweight and high power. In addition, it is possible for it to emit exhaust into the atmosphere because the transmission medium of its energy is air, and it needs neither a tank nor maintenance like hydraulic equipment. In addition, safety to a person and the environment is high because the base of the actuator is a soft polymeric material even if damage to the artificial muscle is caused. On the other hand, because the device is composed of a thin film cylinder, and is easily influenced by outside power for the conversion of the volume change in rubber into physical contraction axially, and its passive character is strong, precise positional control is difficult. However, the living thing that has a verbose degree of freedom enables minute motion and walking, etc. by skillfully adjusting to avoid impedance, because it understands its own muscular characteristic beforehand. Similarly, it is thought that the precise positional control is possible by understanding the characteristics of an artificial muscle beforehand. In this research, it is assumed that the expansion shape of the pneumatic artificial muscle that we developed from the pressure distribution is equivalent to the centenary curve, and its model is based on dynamic balance. The result shows the effectiveness of control of an artificial muscle that uses highly accurate calculations and models.
Searching for social capital: historical perspectives on health, poverty and culture
Authors: Welshman John
Published: October 2006

Social capital has been seen as having a positive effect on health, and the concept of social capital has been viewed as of central importance to debates about healthy, sustainable communities. More generally, behaviour and its relationship with health has become much more central to policy-making, as illustrated in the Choosing Health White Paper (2005), and the concept of social capital has been one influence on the concept of social exclusion. Robert Putnam’s arguments, both those expressed in Making Democracy Work (1993) and the revised version seen in Bowling Alone (2000) have been taken up by numerous social scientists and policy-makers. But despite the explicitly historical perspective that Putnam employs in Bowling Alone in particular, the history of social capital remains rather neglected in the available literature. This article is concerned with providing a historical perspective on social capital, especially the ways in which social investigators have viewed the relationships between health, poverty and behaviour. The article puts social capital alongside that of ‘underclass’ concepts such as the culture of poverty thesis, and examines how the latter has been invented and reinvented in the UK and the USA over the last 120 years. It argues that there are important similarities between the culture of poverty and social capital, but also significant differences, and these have implications for current policy initiatives. One way of analysing concepts like social capital and social exclusion more rigorously is by locating them within this longer-term history of social investigation, in which debates about health, poverty, and culture have been of key significance.
HybGFS: a hybrid method for genome-fingerprint scanning
Authors: Shinoda Kosaku , Yachie Nozomu , Masuda Takeshi , Sugiyama Naoyuki , Sugimoto Masahiro , Soga Tomoyoshi , Tomita Masaru
Published: October 2006

Background

Protein identification based on mass spectrometry (MS) has previously been performed using peptide mass fingerprinting (PMF) or tandem MS (MS/MS) database searching. However, these methods cannot identify proteins that are not already listed in existing databases. Moreover, the alternative approach of de novo sequencing requires costly equipment and the interpretation of complex MS/MS spectra. Thus, there is a need for novel high-throughput protein-identification methods that are independent of existing predefined protein databases.

Results

Here, we present a hybrid method for genome-fingerprint scanning, known as HybGFS. This technique combines genome sequence-based peptide MS/MS ion searching with liquid-chromatography elution-time (LC-ET) prediction, to improve the reliability of identification. The hybrid method allows the simultaneous identification and mapping of proteins without a priori information about their coding sequences. The current study used standard LC-MS/MS data to query an in silico-generated six-reading-frame translation and the enzymatic digest of an entire genome. Used in conjunction with precursor/product ion-mass searching, the LC-ETs increased confidence in the peptide-identification process and reduced the number of false-positive matches. The power of this method was demonstrated using recombinant proteins from the Escherichia coli K12 strain.

Conclusion

The novel hybrid method described in this study will be useful for the large-scale experimental confirmation of genome coding sequences, without the need for transcriptome-level expression analysis or costly MS database searching.
Integration of enzyme kinetic models and isotopomer distribution analysis for studies of in situcell operation
Authors: Selivanov Vitaly A , Sukhomlin Tatiana , Centelles Josep J , Lee Paul WN , Cascante Marta
Published: October 2006

A current trend in neuroscience research is the use of stable isotope tracers in order to address metabolic processes in vivo. The tracers produce a huge number of metabolite forms that differ according to the number and position of labeled isotopes in the carbon skeleton (isotopomers) and such a large variety makes the analysis of isotopomer data highly complex. On the other hand, this multiplicity of forms does provide sufficient information to address cell operation in vivo. By the end of last millennium, a number of tools have been developed for estimation of metabolic flux profile from any possible isotopomer distribution data. However, although well elaborated, these tools were limited to steady state analysis, and the obtained set of fluxes remained disconnected from their biochemical context. In this review we focus on a new numerical analytical approach that integrates kinetic and metabolic flux analysis. The related computational algorithm estimates the dynamic flux based on the time-dependent distribution of all possible isotopomers of metabolic pathway intermediates that are generated from a labeled substrate. The new algorithm connects specific tracer data with enzyme kinetic characteristics, thereby extending the amount of data available for analysis: it uses enzyme kinetic data to estimate the flux profile, and vice versa, for the kinetic analysis it uses in vivo tracer data to reveal the biochemical basis of the estimated metabolic fluxes.
Transition of healthy to diseased synovial tissue in rheumatoid arthritis is associated with gain of mesenchymal/fibrotic characteristics
Authors: Steenvoorden Marjan MC , Tolboom Tanja CA , van der Pluijm Gabri , Löwik Clemens , Visser Cornelis PJ , DeGroot Jeroen , Gittenberger-DeGroot Adriana C , DeRuiter Marco C , Wisse Bert J , Huizinga Tom WJ , Toes René EM
Published: October 2006

The healthy synovial lining layer consists of a single cell layer that regulates the transport between the joint cavity and the surrounding tissue. It has been suggested that abnormalities such as somatic mutations in the p53 tumor-suppressor gene contribute to synovial hyperplasia and invasion in rheumatoid arthritis (RA). In this study, expression of epithelial markers on healthy and diseased synovial lining tissue was examined. In addition, we investigated whether a regulated process, resembling epithelial to mesenchymal transition (EMT)/fibrosis, could be responsible for the altered phenotype of the synovial lining layer in RA. Synovial tissue from healthy subjects and RA patients was obtained during arthroscopy. To detect signs of EMT, expression of E-cadherin (epithelial marker), collagen type IV (indicator of the presence of a basement membrane) and α-smooth muscle actin (α-sma; a myofibroblast marker) was investigated on frozen tissue sections using immunohistochemistry. Fibroblast-like synoviocytes (FLSs) from healthy subjects were isolated and subjected to stimulation with synovial fluid (SF) from two RA patients and to transforming growth factor (TGF)-β. To detect whether EMT/fibrotic markers were increased, expression of collagen type I, α-sma and telopeptide lysylhydroxylase (TLH) was measured by real time PCR. Expression of E-cadherin and collagen type IV was found in healthy and arthritic synovial tissue. Expression of α-sma was only found in the synovial lining layer of RA patients. Stimulation of healthy FLSs with SF resulted in an upregulation of α-sma and TLH mRNA. Collagen type I and TLH mRNA were upregulated after stimulation with TGF-β. Addition of bone morphogenetic protein (BMP)-7 to healthy FLS stimulated with SF inhibited the expression of α-sma mRNA. The finding that E-cadherin and collagen type IV are expressed in the lining layer of healthy and arthritic synovium indicates that these lining cells display an epithelial-like phenotype. In addition, the presence of α-sma in the synovial lining layer of RA patients and induction of fibrotic markers in healthy FLSs by SF from RA patients indicate that a regulated process comparable to EMT might cause the alteration in phenotype of RA FLSs. Therefore, BMP-7 may represent a promising agent to counteract the transition imposed on synoviocytes in the RA joint.
Heterotopic ossification of the knee joint in intensive care unit patients: early diagnosis with magnetic resonance imaging
Authors: Argyropoulou Maria I , Kostandi Eleonora , Kosta Paraskevi , Zikou Anastasia K , Kastani Dimitra , Galiatsou Efi , Kitsakos Athanassios , Nakos George
Published: October 2006

Introduction

Heterotopic ossification (HO) is the formation of bone in soft tissues. The purpose of the present study was to evaluate the magnetic resonance imaging (MRI) findings on clinical suspicion of HO in the knee joint of patients hospitalised in the intensive care unit (ICU).

Methods

This was a case series of 11 patients requiring prolonged ventilation in the ICU who had the following diagnoses: head trauma (nine), necrotising pancreatitis (one), and fat embolism (one). On clinical suspicion of HO, x-rays and MRI of the knee joint were performed. Follow-up x-rays and MRI were also performed.

Results

First x-rays were negative, whereas MRI (20.2 ± 6.6 days after admission) showed joint effusion and in fast spin-echo short time inversion-recovery (STIR) images a 'lacy pattern' of the muscles vastus lateralis and medialis. The innermost part of the vastus medialis exhibited homogeneous high signal. Contrast-enhanced fat-suppressed T1-weighted images also showed a 'lacy pattern.' On follow-up (41.4 ± 6.6 days after admission), STIR and contrast-enhanced T1-weighted images depicted heterogeneous high signal and heterogeneous enhancement, respectively, at the innermost part of the vastus medialis, whereas x-rays revealed a calcified mass in the same position. Overall, positive MRI findings appeared simultaneously with clinical signs (1.4 ± 1.2 days following clinical diagnosis) whereas x-ray diagnosis was evident at 23 ± 4.3 days (p = 0.002).

Conclusion

MRI of the knee performed on clinical suspicion shows a distinct imaging pattern confirming the diagnosis of HO earlier than other methods. MRI diagnosis may have implications for early intervention in the development of HO.
CellProfiler: image analysis software for identifying and quantifying cell phenotypes
Authors: Carpenter Anne E , Jones Thouis R , Lamprecht Michael R , Clarke Colin , Kang In Han , Friman Ola , Guertin David A , Chang Joo Han , Lindquist Robert A , Moffat Jason , Golland Polina , Sabatini David M
Published: October 2006

Biologists can now prepare and image thousands of samples per day using automation, enabling chemical screens and functional genomics (for example, using RNA interference). Here we describe the first free, open-source system designed for flexible, high-throughput cell image analysis, CellProfiler. CellProfiler can address a variety of biological questions quantitatively, including standard assays (for example, cell count, size, per-cell protein levels) and complex morphological assays (for example, cell/organelle shape or subcellular patterns of DNA or protein staining).
A consensus prognostic gene expression classifier for ER positive breast cancer
Authors: Teschendorff Andrew E , Naderi Ali , Barbosa-Morais Nuno L , Pinder Sarah E , Ellis Ian O , Aparicio Sam , Brenton James D , Caldas Carlos
Published: October 2006

Background

A consensus prognostic gene expression classifier is still elusive in heterogeneous diseases such as breast cancer.

Results

Here we perform a combined analysis of three major breast cancer microarray data sets to hone in on a universally valid prognostic molecular classifier in estrogen receptor (ER) positive tumors. Using a recently developed robust measure of prognostic separation, we further validate the prognostic classifier in three external independent cohorts, confirming the validity of our molecular classifier in a total of 877 ER positive samples. Furthermore, we find that molecular classifiers may not outperform classical prognostic indices but that they can be used in hybrid molecular-pathological classification schemes to improve prognostic separation.

Conclusion

The prognostic molecular classifier presented here is the first to be valid in over 877 ER positive breast cancer samples and across three different microarray platforms. Larger multi-institutional studies will be needed to fully determine the added prognostic value of molecular classifiers when combined with standard prognostic factors.
The new curriculum for psychiatric training
Authors: Bhugra Dinesh
Published: October 2006

The UK's Postgraduate Medical Education and Training Board (PMETB) went live on 30 September 2005. This editorial summarises the state of play and informs members of the Royal College of Psychiatrists and stakeholders of the changes that have taken place in the intervening year and of the College's response. The College has received provisional approval of its core curriculum, and specialty curricula have been submitted for approval. We are in the middle of pilot work on workplace-based assessments and preliminary results should be available in the early part of 2007, when trainees and educational supervisors will begin training in the preparation for and carrying out of these assessments.
Helping patients with paranoid and suspicious thoughts: a cognitive–behavioural approach
Authors: Freeman Daniel , Garety Philippa
Published: October 2006

Paranoid and suspicious thoughts are a significant clinical topic. They regularly occur in 10–15% of the general population, and persecutory delusions are a frequent symptom of psychosis. In the past, patients were discouraged from talking about paranoid experiences. In contrast, it is now recommended that patients are given time to talk about them, and cognitive–behavioural techniques are being used to reduce distress. In this article we present the theoretical understanding of paranoia that underpins this transformation in the treatment of paranoid thoughts and summarise the therapeutic techniques derived. Emphasis is placed on the clinician approaching the problem from a perspective of understanding and making sense of paranoid experiences rather than simply challenging paranoid thoughts. Ways of overcoming difficulties in engaging people with paranoid thoughts are highlighted.
Dare to be wise
Authors: Shooter Mike
Published: October 2006

It is remarkable that any of the advice given to medical students 70 years ago should still be relevant today. But none of it now makes sense without reference to the two-way relationship we share with our patients. We should be asking not what the doctor should be blessed with by the world, but what the patient should require of the doctor. This would include humanity, humility, honesty and especially wisdom.
Clinic assessment for methylphenidate maintenance therapy in secondary care: are parental questionnaires useful?
Authors: Foreman David M. , Beedie Alexis , Kapuge Ranjit
Published: October 2006

Aims and Method

There is poorer control of hyperactivity symptoms in community clinics than research settings, and difficulty in detecting such symptoms without standardised measures. Hyperkinetic children (n=29) were evaluated at follow-up using the parental version of the Strengths and Difficulties Questionnaire (SDQ) and, independently, routine clinic reports to test the value of a parental questionnaire.

Results

The parental SDQ identified symptoms in more patients (25, 86% v. 13, 45%), but high levels of symptoms did not necessarily imply impairment. Even clinically identified hyperactivity provoked no change in treatment.

Clinical Implications

Parental questionnaires alone are unlikely to improve clinic practice. Research is needed into what factors influence clinical decisions regarding treatment maintenance for hyperkinesis, and the adaptation of structured protocols from major research trials should be considered.
Introduction of New Technologies to Competing Industrial Customers
Authors: Erat Sanjiv , Kavadias Stylianos
Published: October 2006

Motivated by several examples from industry, such as the introduction of a biotechnology-based process innovation in nylon manufacturing, we consider a technology provider that develops and introduces innovations to a market of industrial customers—original equipment manufacturers (OEMs). The technology employed by these OEMs determines the performance quality of the end product they manufacture, which in turn forms the basis of competition among them. Within this context of downstream competition, we examine the technology provider’s introduction strategies when improving technologies are introduced sequentially.

We develop a two-period game-theoretic framework to account for the strategic considerations of the parties involved (i.e., the technology provider and the OEMs). Our main result indicates that the technology provider may find it beneficial to induce partial adoption of the new technology, depending on the technological progress the provider intends to offer in the future. We analyze many technology-specific and market-related characteristics—such as volume-based pricing for new component technologies, upgrade prices, and OEMs with differing capabilities—that correspond to various business settings. Our key result (i.e., partial adoption) proves to be a robust phenomenon. We also develop additional insights regarding the interactions between adoption and OEM capabilities.
Some Empirical Regularities in Market Shares
Authors: Kohli Rajeev , Sah Raaj
Published: October 2006

We present some empirical regularities in the market shares of brands. Our cross-sectional data on market shares consists of 1,171 brands in 91 product categories of foods and sporting goods sold in the United States. One of our results is that the pattern of market shares for each of the categories (many of which are fundamentally dissimilar, such as breakfast cereals and rifles) is represented well by the power law. The power law also does better than an alternative model—namely, the exponential form—which has previously been studied in the literature but without having been compared to any alternative. These two models have sharply different implications; for example, the power law predicts that the ratio of market shares for two successively ranked brands becomes smaller as one progresses from higher-ranked to lower-ranked brands, whereas the exponential form predicts that this ratio is a constant. Our findings have several managerial and research implications, which we summarize.
A Typology of Plants in Global Manufacturing Networks
Authors: Vereecke Ann , Van Dierdonck Roland , De Meyer Arnoud
Published: October 2006

The purpose of this paper is to propose a new, empirically derived typology of plants in the international manufacturing network of multinational companies. This typology is based on the knowledge flows between the plants. In our research, network analysis has been used as a methodology for understanding the position of plants in international manufacturing networks. The focus has been primarily on the intangible knowledge network, and secondarily on the physical, logistic network. Our analysis leads to four types of plants with different network roles: the isolated plants, the receivers, the hosting network players, and the active network players. Our analysis shows that the different types of plants play a different strategic role in the company, have a different focus, and differ in age, autonomy, and level of resources and investments. Also, the analysis suggests that the evolution of the plant depends to some extent on the network role of the plant. Finally, two scenarios for the development of a strong network role are identified. The research is useful for the scholar studying the architecture of knowledge networks, as well as for the practitioner who is in charge of an international network of manufacturing units.
A Fractiles Perspective to the Joint Price/Quantity Newsvendor Model
Authors: Raz Gal , Porteus Evan L.
Published: October 2006

Pricing and quantity decisions are critical to many firms across different industries. We study the joint price/quantity newsvendor model where only a single quantity and price decision is made, such as a fashion or holiday product that cannot be replenished and where the price is advertised nationally and cannot be changed. Demand is uncertain and sensitive to price. We develop a method for easily finding the optimal price and quantity that applies to more general cases than the usual one in which uncertainty is either additive, multiplicative, or a combination of the two. We represent a quantity by its fractile of the probability distribution of demand for a given price. We use a standard approach to approximating a given distribution with a finite number of representative fractiles and assume that these fractile functions are piecewise linear functions of the price. We identify effects that are not usually seen in a joint price/quantity newsvendor model. For example, although the optimal quantity is a decreasing function of the unit cost, the optimal price can be nonmonotone in the unit cost and we shed insight into why. We illustrate that using a simplified structure of demand uncertainty can result in substantially lower profits.
Organizational Design and the Intensity of Rivalry
Authors: Vroom Govert
Published: October 2006

We analyze the effect of managerial compensation schemes and organizational structure on competitive behavior in imperfectly competitive product markets. Previous research suggests that in cases of strategic substitutability, firms tend to choose organizational structures and compensation systems that commit the firm to behaving aggressively in the product market, reducing firm and industry profits. In contrast, we show that while compensation and structure in isolation lead to excessive aggressiveness, the combination of these two internal choice variables may reverse the outcome—organizational design can be used as a commitment device to reduce competitive rivalry. Finally, we find that in equilibrium, firms may choose to be different; one firm is decentralized and uses incentives that commit it to being aggressive, while the other is centralized and uses incentives that commit it to being soft. Hence, endogenous firm heterogeneity in the form of organizational differentiation allows firms to avoid a mutually detrimental outcome.
The effect of irradiation upon the bacterial flora in patients with head and neck cancer
Authors: Rice Dale H. , Gill Gus
Published: October 2006

Twenty‐two consecutive patients with cancer of the head and neck, who were to receive a full tumoricidal dose of irradiation to a field that included the oral cavity and pharynx, were studied to determine the effect of the irradiation on their local bacterial flora. Aerobic cultures were taken prior to, at the completion of, and one month after the completion of their irradiation. The percentage of patients with potentially pathogenic organisms increased dramatically as the effect of the irradiation increased. This change in the local flora has obvious implications concerning the increased incidence of postoperative wound infections in patients who have received prior irradiation.
Tonsil carcinoma — treatment results
Authors: Quenelle David J. , Crissman John D. , Shumrick Donald A.
Published: October 2006

Epidermoid carcinoma of the tonsil region is one of the most common malignancies of the upper aerodigestive tract, equal in frequency to laryngeal carcinoma at the University of Cincinnati Medical Center. This paper reviews the authors' experience in treating these lesions with a combination of 5000 rads preoperatively followed by composite resection. The overall two‐year crude survival is 56%. A 60% two‐year survival for T3 lesions compares favorably with other series for treatment of T3 lesions.
Intractable hiccups (Singultus)
Authors: Nathan Marshall D. , Leshner Robert T. , Keller A. Paul
Published: October 2006

Intractable hiccups (singultus) is an uncommon disorder with various etiologies. The majority of reported studies of intractable hiccups has claimed ipsilateral spasm of the hemidiaphragm based solely on clinical or radiographic evidence.

A case of intractable hiccups is presented. Documentation of normal phrenic nerve latencies with bilateral synchronous firing of anterior scalene, intercostal muscles and bilateral hemidiaphragm involvement is presented. This combination of muscle group involvement supports the concept of a “supraspinal hiccup center.” A systematic trial of chemotherapeutic agents described as effective against hiccups was employed. Relief lasting for three to four week periods has been obtained by the intravenous administration of a specially prepared sterile solution of methylphenidate.†

The nerve pathways pertinent to hiccup are discussed. The etiology of intractable hiccups and the various treatment modalities are presented.
Draining ears in acute otitis media: Reliability of culture
Authors: Schwartz Richard H. , Rodriguez William J.
Published: October 2006

The purulent exudates in the ear canal of 69 children who presented with acute otorrhea were cultured directly onto standard media. No effort was made to either suction out the exudate lying in the canal or to use antiseptic agents on the canal wall. Potential pathogens such as H. influenzae, S. pneumoniae and S. pyogenous were recovered from two‐thirds of the patients who suffered spontaneous otorrhea. Reliable cultures can be obtained from such patients provided the cultures are plated expeditiously on solid agar.
Human nasal septal cartilage: Local distribution of different enzyme activities in healthy adults and acromegalic patients
Authors: Vetter Ulrich , Helbing Gerd , Pirsig Wolfgang , Heinze Eberhard , Gammert Christian , Landolt Anton
Published: October 2006

Septal cartilage was obtained during septoplasty from healthy adults or during transnasal hypophysectomy from acromegalic patients. Small strips of cartilage were excised from five different areas of the septum: the anterior free end, the suprapremaxillary area, the central area, the posterior area, and the caudal prolongation of the septum. Five different enzymatic pathways were analyzed in these areas.

Cathepsin D, an acid proteinase, did not show a specific local activity pattern and was not influenced by the augmented growth hormone level in acromegaly, whereas cathepsin B, a neutral proteinase, showed its highest activity in the caudal prolongation and the posterior area and was significantly increased in all areas in acromegaly. β‐hexosaminidase activity was highest in the central and posterior area and caudal prolongation of the septum. In acromegaly, a significant increase of its activity was found in the suprapremaxillary and posterior area. Acid phosphatase activity was highest in the caudal prolongation of the septum, but its activity was significantly increased in all tested areas in acromegaly. Alkaline phosphatase activity could only be found in the posterior area and the caudal prolongation in healthy adults. However, in acromegaly this enzyme could be detected in the central area and the posterior end of the suprapremaxillary area suggesting an altered process of mineralization.

A distinct local pattern of enzymes related to intercellular substance metabolism and mineralization can be demonstrated in the septal cartilage of healthy adults and acromegalic patients.
Internal jugular vein thrombosis
Authors: Cohen Jason P. , Persky Mark S. , Reede Deborah L.
Published: October 2006

Internal jugular vein thrombosis is a vascular disorder that is easily overlooked or misdiagnosed. It occurs in a variety or clinical settings which disrupt normal blood flow through the internal jugular vein. Intravenous drug abusers represent a high risk group in this study. Diagnosis is readily made by computed tomography. Seven patients are presented, with discussion of the pathogenesis, clinical findings, radiologic features, potential complications, and treatment rationale.
Complications of endoscopic sinus surgery: Analysis of 2108 patients—incidence and prevention
Authors: May Mark , Levine Howard L. , Mester Sara J. , Schaitkin Barry
Published: October 2006

The incidence of complications of endoscopic sinus surgery (ESS) in a combined experience with 2108 total patients is compared to complications in 11 other series of patients (2583 total) who underwent ESS and 6 series of patients (2110 total) who underwent traditional endonasal sinus surgery. The incidence of major perioperative complications was 0.85%, with cerebrospinal fluid (CSF) leak being the most common. The most common minor complications of ESS were those related to orbital penetration and middle turbinate adhesions; minor complications occurred in 6.9% of the 2108 patients. There were no statistically significant differences in the overall incidences of major complications between this series and the other two groups. Recommendations are made for the prevention of complications during ESS.
Variables affecting implant performance in children
Authors: Miyamoto Richard T. , Osberger Mary Joe , Todd Susan L. , Robbins Amy M. , Stroer Barbara S. , Zimmerman‐Phillips Susan , Carney Arlene E.
Published: October 2006

This study examined the variables that contribute to the large individual differences in the speech perception skills of children with the Nucleus multichannel cochlear implant. Sixty‐one children were tested on four measures of speech perception: two tests of closed‐set word recognition, one test of open‐set recognition of phrases, and one open‐set monosyllabic word test, scored on the basis of the percentage of phonemes as well as words identified correctly. The results of a series of multiple regression analyses revealed that the variables of processor type, duration of deafness, communication mode, age at onset of deafness, length of implant use, and age implanted accounted for roughly 35% of the variance on two tests of closed‐set word recognition, and 40% of the variance on measures that assessed recognition of words or phomenes in an open set. Length of implant use accounted for the most variance on all of the speech perception measures.
Hypothyroidism in head and neck cancer patients: Experimental and clinical observations
Authors: Cannon C. Ron
Published: October 2006

Damage to the thyroid gland may occur in patients undergoing treatment for head and neck neoplasms. This injury may result from damage incurred during surgery, from radiation therapy, or a combination of the two. Development of hypothyroidism is often insidious with potential harmful effects.

An experimental study was performed to study the effects of hypothyroidism in pigs whose skin closely approximates that of the human. Wound tensile strength and flap necrosis were studied in the hypothyroid animal treated by surgery, radiation, and a combination of the two. The results of this study indicate that hypothyroidism alone has no significant unfavorable impact on wound tensile strengths or flap survival. When combined with preoperative radiation, however, there are statistically significant deleterious effects on both wound tensile strengths and flap survival. Histologically, collagen fibers within the wound appear shorter and thinner, which probably accounts for decreased wound tensile strengths.

A clinical review of 62 head and neck cancer patients was also conducted. Within the study group, 10% of patients developed abnormally low thyroxine measurements, whereas 15% developed high thyroid‐stimulating hormone levels as the only evidence of early primary hypothyroidism. Hypothyroidism was not statistically related to tumor size, nodal status, clinical staging, or treatment group (surgery alone, radiation alone, or combination surgery and radiation). A previously unreported finding is that patients who develop a second primary tumor are significantly at risk for developing hypothyroidism.

All patients diagnosed with a head and neck cancer should undergo baseline thyroid function testing, including measurement of TSH, and have serial repeat testing after treatment. Thyroid function determination should be mandatory in patients undergoing oncologic salvage procedures or treatment of a second primary tumor.
The Development and Testing of a Performance Checklist to Assess Neonatal Resuscitation Megacode Skill
Authors: Lockyer Jocelyn , Singhal Nalini , Fidler Herta , Weiner Gary , Aziz Khalid , Curran Vernon
Published: October 2006

PURPOSE. The purpose of this work was to develop and assess the feasibility, reliability, and validity of a brief performance checklist to evaluate skills during a simulated neonatal resuscitation (“megacode”) for the Neonatal Resuscitation Program of the American Academy of Pediatrics.

METHODS. A performance checklist of items was created, validated, and modified in sequential phases involving: an expert committee, review, and feedback by Neonatal Resuscitation Program instructors for feasibility and criticality and use of the performance checklist by Neonatal Resuscitation Program instructors reviewing videotaped megacodes. The final 20-item performance checklist used a 3-point scale and was assessed by student and instructor volunteers. Megacode scores, the NRP multiple-choice examination scores, student assessments of their ability and performance, and sociodemographic descriptors for both students and instructors were collected. Data were analyzed descriptively. In addition, we assessed the megacode score internal consistency reliability, the correlations between megacode and multiple-choice examination scores, and the variance in scores based on instructor and student characteristics.

RESULTS. A total of 468 students and 148 instructors volunteered for the study. The instrument was reliable and internally consistent. Student's scores were high on most items. There was a significant but low correlation between the megacode score and the written knowledge examination. Instructor and student characteristics had little effect on the variance in scores.

CONCLUSIONS. This performance checklist provides a feasible assessment tool. There is evidence for its reliability and validity.
Clinical Value of Immunoglobulin A Antitransglutaminase Assay in the Diagnosis of Celiac Disease
Authors: Diamanti Antonella , Colistro Franco , Calce Angelica , Devito Rita , Ferretti Francesca , Minozzi Antonio , Santoni Alexandra , Castro Massimo
Published: October 2006

OBJECTIVES. Our goal was to evaluate the possible correspondence between antitissue transglutaminase of immunoglobulin A class levels and stage of mucosal damage in patients affected by celiac disease. In addition, we assessed clinical use of antitissue transglutaminase values to predict biopsy results.

METHODS. One thousand eight hundred eighty-six consecutive patients with symptoms suggestive of celiac disease and 305 healthy controls underwent determination of serum levels of immunoglobulin A and antitissue transglutaminase. An intestinal biopsy was performed in subjects with antitissue transglutaminase levels ≥4 IU/mL and in subjects with negative antitissue transglutaminase levels but with clinical suspicion of celiac disease. Histologic grading of celiac disease was consistent with the Marsh classification.

RESULTS. One hundred eighty-six subjects with positive antitissue transglutaminase levels and 91 patients with negative antitissue transglutaminase levels were submitted to biopsy. In all healthy subjects, antitissue transglutaminase results were negative. Histologic evaluations in patients with positive antitissue transglutaminase levels gave the following results: type 0 in 25 patients, type 1 in 3 patients, type 2 in 4 patients, type 3a in 22 patients, type 3b in 74 patients, and type 3c in 58 patients. None of the patients with negative antitissue transglutaminase levels showed histologic findings suggestive of celiac disease. The mean antitissue transglutaminase values in patients without mucosal atrophy were significantly lower than in patients with mucosal atrophy. Antitissue transglutaminase values ≥20 IU/mL were found in only 1 patient without mucosal atrophy.

CONCLUSIONS. Our study found a strong correspondence between antitissue transglutaminase levels and stage of mucosal injury; antitissue transglutaminase values >20 IU/mL seemed to be strongly predictive of mucosal atrophy.
Increasing Prevalence of Cerebral Palsy Among Very Preterm Infants: A Population-Based Study
Authors: Vincer Michael J. , Allen Alexander C. , Joseph K. S. , Stinson Dora A. , Scott Heather , Wood Ellen
Published: October 2006

OBJECTIVES. It is unclear whether declines in neonatal and infant mortality have led to changes in the occurrence of cerebral palsy. We conducted a study to examine and investigate recent temporal changes in the prevalence of cerebral palsy in a population-based cohort of very preterm infants who were 24 to 30 weeks of gestational age.

METHODS. A population-based cohort of very preterm infants who were born between January 1, 1993, and December 31, 2002, was evaluated by the Perinatal Follow-up Program of Nova Scotia. Follow-up extended to age 2 years to ascertain the presence or absence of cerebral palsy and for overall survival. Infant survival and cerebral palsy rates were compared by year and also in two 5-year periods, 1993–1997 and 1998–2002. Logistic regression analyses were used to identify factors that potentially were responsible for temporal changes in cerebral palsy rates.

RESULTS. A total of 672 liveborn very preterm infants were born to mothers who resided in Nova Scotia between 1993 and 2002. Infant mortality among very preterm infants decreased from 256 per 1000 live births in 1993 to 114 per 1000 live births in 2002, whereas the cerebral palsy rates increased from 44.4 per 1000 live births in 1993 to 100.0 per 1000 live births in 2002. Low gestational age, postnatal dexamethasone use, patent ductus arteriosus, severe hyaline membrane disease, resuscitation in the delivery room, and intraventricular hemorrhage were associated with higher rates of cerebral palsy, whereas antenatal corticosteroid use was associated with a lower rate.

CONCLUSION. Cerebral palsy has increased substantially among very preterm infants in association with and possibly as a consequence of large declines in infant mortality.
Expression of Matrix Metalloproteinases (MMP‐8 and ‐9) in Chronic Periodontitis Patients With and Without Diabetes Mellitus
Authors: Kumar Muthusamy Senthil , Vamsi Gelli , Sripriya Ramasamy , Sehgal Praveen Kumar
Published: October 2006

Background:Matrix metalloproteinases (MMPs) are involved in a number of physiological events, and they are the major players in collagen breakdown during periodontal tissue destruction. Diabetes mellitus (DM) has been associated with altered collagen metabolism and increases the response of the periodontal tissue to pathogenic microorganisms, thereby increasing the severity of periodontal disease. The aim of this study was to assess the expression of MMP‐8 and ‐9 in gingival tissues of diabetic chronic periodontitis (CP), non‐diabetic CP, and healthy patients.

Methods:The plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were assessed. The levels of MMP expression in gingival tissue extracts were measured by gelatin zymography and Western blotting. The structural changes in tissues were analyzed by histological examination and collagen estimation.

Results:Higher levels of PI, GI, CAL, and deeper PD were observed in CP patients with DM than CP patients without DM. The average concentration of MMP‐9 was increased three‐fold, and the MMP‐8 was increased two‐fold in CP patients with DM compared to CP patients without DM. A high infiltration of inflammatory cells and less collagen were observed in the histologic analysis of gingival biopsies from diabetic patients.

Conclusions:An increased concentration of MMP‐8 and ‐9 in the gingival tissue of diabetic CP patients suggests that the expression of these MMPs contributes to the failure of the healing process in the diabetic condition. Treatment strategies directed toward the inhibition of these MMPs could lead to an improved healing rate in CP patients.
Matrix Metalloproteinase‐13 Is Highly Expressed in Destructive Periodontal Disease Activity
Authors: Hernandez Marcela , Valenzuela Maria Antonieta , Lopez‐Otin Carlos , Alvarez Jesús , Lopez Jose Manuel , Vernal Rolando , Gamonal Jorge
Published: October 2006

Background: Matrix metalloproteinases (MMPs) participate in extracellular matrix degradation in physiological and pathological conditions. The available evidence suggests that MMP‐13 plays a significant role in both the initiation and progress of bone resorption. The aim of our study was to identify the presence of MMP‐13 in adult patients with untreated chronic periodontitis. We also determined the activity of MMP‐13 present in lesions undergoing episodic attachment loss in gingival crevicular fluid (GCF) samples.

Methods: After monitoring at 2 and 4 months, 21 patients showed destructive periodontitis (periodontally affected sites presenting at least two sites with ≥2 mm clinical attachment loss), and GCF samples were collected both from active and inactive sites (21 GCF samples, each). GCF was collected during a 30‐second interval using a paper strip, and an immunofluorescence assay was performed to determine the basal activity of MMP‐13 and the relationship between 4‐aminophenylmercuric acetate (APMA)‐activated total MMP‐13 and basal MMP‐13 activity. Gingival tissues from five patients were fixed in formalin and MMP‐13 expression was demonstrated using immunohistochemistry and in situ hybridization. MMP‐13 molecular forms were examined by Western immunoblotting with monoclonal antibodies.

Results: MMP‐13 was found in 100% of GCF samples from patients with chronic periodontitis. Active sites, associated with tissue destruction, had significantly higher proportions of active MMP‐13 and MMP‐13 activity levels than their inactive counterparts (1.49 versus 1.17 ng fluorescent product, respectively; P <0.05). Western blot, immunohistochemical staining, and in situ hybridization confirmed the presence of MMP‐13 in periodontal disease, with observable differences between periodontitis and healthy subjects. MMP‐13 immunoreactivities were seen mainly as 55 and 48 kDa, corresponding to partially and fully activated forms, respectively, and a smaller proportion of 60‐kDa proenzyme form.

Conclusion: MMP‐13 activity in GCF samples was significantly increased in active sites from progressive periodontal disease, supporting its role in the alveolar bone loss developed in this disease.
Treatment of Intrabony Defects With an Enamel Matrix Protein Derivative or Bioabsorbable Membrane: An 8‐Year Follow‐Up Split‐Mouth Study
Authors: Sculean Anton , Schwarz Frank , Miliauskaite Asta , Kiss Alice , Arweiler Nicole , Becker Jürgen , Brecx Michel
Published: October 2006

Background: Treatments with either an enamel matrix protein derivative (EMD) or guided tissue regeneration (GTR) have been shown to promote periodontal regeneration. However, until recently, only limited data have been available on the long‐term clinical results following these regenerative techniques. Therefore, the aim of this study was to present the 8‐year results of a prospective, controlled, split‐mouth clinical study evaluating the treatment of intrabony defects with EMD or GTR.

Methods: Ten patients, each of whom displayed one pair of intrabony defects located contralaterally in the same jaw, were randomly treated with EMD or with GTR by means of bioabsorbable membranes. The following clinical parameters were evaluated at baseline and at 1 and 8 years after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). The primary outcome variable was CAL. No statistically significant differences between the groups were found at baseline.

Results: The sites treated with EMD demonstrated a mean CAL change from 9.5 ± 1.2 mm to 6.3 ± 1.3 mm (P <0.001) and 6.7 ± 1.6 mm (P <0.001) at 1 and 8 years, respectively. No statistically significant differences were found between the 1‐ and 8‐year results. Sites treated with GTR showed a mean CAL change from 9.7 ± 1.3 mm to 6.7 ± 0.9 mm (P <0.001) at 1 year and 6.8 ± 1.2 mm (P <0.001) at 8 years. The CAL change between 1 and 8 years did not present statistically significant differences. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and at 8 years. However, the study does not have the statistical power to rule out the possibility of a difference between the two groups.

Conclusions: Within their limits, the present results indicate the following: 1) the clinical improvements obtained following treatment with EMD or GTR can be maintained over a period of 8 years; and 2) further studies of much higher power need to be performed to support equivalence.