bluuebunny/crossref_metadata_2025 huggingface dataset:
Toll‐like receptors differentially induce nucleosome remodelling at the IL‐12p40 promoter
Authors: Albrecht Inka , Tapmeier Thomas , Zimmermann Stefan , Frey Markus , Heeg Klaus , Dalpke Alexander
Published: January 2004

Toll‐like receptors (TLRs) mediate recognition of microbial components. Despite activation of a shared set of signal transduction molecules, the biological effects of certain TLR agonists differ considerably. In macrophages and dendritic cells, stimulation by the prototypical stimuli CpG‐DNA (TLR9), lipopolysaccharide (LPS; TLR4) and lipoteichoic acid (LTA; TLR2) resulted in striking differences in expression of IL‐12. However, these stimuli induced similar amounts of the common proinflammatory cytokine TNFα. Surprisingly, an IL‐12p40 promoter reporter construct was activated equally by CpG‐DNA, LPS and LTA. Examinations of the chromatin structure of the endogenous IL‐12p40 promoter revealed that nucleosome remodelling contributed to differential IL‐12 induction. Upon stimulation, nucleosome architecture was changed to provide increased access to the IL‐12p40 promoter. In dendritic cells, a differential induction of nucleosome remodelling at the IL‐12p40 promoter was observed upon triggering with different TLR agonists. These results identify nucleosome remodelling as an additional restriction point in differential TLR signalling.
p41‐Arc subunit of human Arp2/3 complex is a p21‐activated kinase‐1‐interacting substrate
Authors: Vadlamudi Ratna K , Li Feng , Barnes Christopher J , Bagheri‐Yarmand Rozita , Kumar Rakesh
Published: January 2004

The formation of new branched actin filament networks at the cell cortex of migrating cells is choreographed by the actin‐related protein (Arp) 2/3 complex. Despite the fundamental role of the Arp2/3 complex in actin nucleation and branching, upstream signals that control the functions of p41‐Arc, a putative regulatory component of the mammalian Arp2/3 complex, remain unidentified. Here we show that p41‐Arc interacts with p21‐activated kinase 1 (Pak1) both in vitro and in vivo. Pak1 phosphorylation of p41‐Arc regulates its localization with the Arp2/3 complex in the cortical nucleation regions of cells. Pak1 phosphorylates p41‐Arc on threonine 21 in the first WD repeat, and its mutation has functional implications in vivo. Threonine 21 phosphorylation by Pak1 is required for both constitutive and growth‐factor‐induced cell motility. Pak1 regulation of p41‐Arc activation status represents a novel mechanism by which signalling pathways may influence the functions of the Arp2/3 complex, leading to motility in mammalian cells.
Type, extent and use of colours in ready‐to‐eat (RTE) foods prepared in the non‐industrial sector – a case study from Hyderabad, India
Authors: Jonnalagadda Padmaja R. , Rao Pratima , Bhat Ramesh V. , Nadamuni Naidu A.
Published: February 2004

The type and extent of colours added to ready‐to‐eat (RTE) foods prepared in the non‐industrial sector of India was investigated. Of the 545 RTE foods analysed, 90% contained permitted colours, 2% contained a combination of permitted and non‐permitted colours and 8% contained only non‐permitted colours. However in RTE foods with permitted colours, 73% exceeded 100 ppm, as prescribed by the Prevention of Food Adulteration Act of India, and 27% were within the prescribed levels. Among the permitted colours, tartrazine was the most widely used colour followed by sunset yellow. The maximum concentration of colours was detected in sweet meats (18 767 ppm), non‐alcoholic beverages (9450 ppm), miscellaneous foods (6106 ppm) and hard‐boiled sugar confectioneries (3811 ppm). Among the non‐permitted colours found, rhodamine was most commonly used. Some of the foods, such as savouries and miscellaneous foods like sugar coated aniseed and almond milk, are not supposed to contain colours as per the Prevention of Food Adulteration Act, but were found to contain colours.
Phylogeography of the High Alpine Cushion Plant Androsace alpina (Primulaceae) in the European Alps
Authors: Schönswetter P. , Tribsch A. , Niklfeld H.
Published: February 2004

Abstract: Recent studies elucidating the glacial history of alpine plants have yielded controversial results. While some have favoured glacial survival on mountain tops above the glaciers (nunataks), others did not find support for this hypothesis. Furthermore, all of the published phylogeographic patterns are strikingly different. In order to provide more data for a future comparative phylogeographical approach, we investigated 53 populations of the high alpine cushion plant Androsace alpina (Primulaceae), endemic to the European Alps, using amplified fragment length polymorphism (AFLP). While Principal Co‐ordinate Analysis (PCoA) of populations revealed four genetically‐defined phylogeographical groups corresponding to geographic regions, Neighbour Joining analysis (NJ) separated only three groups. Mantel tests were used to assess the goodness‐of‐fit between the grouping in PCoA and the genetic similarity matrix, and these showed high similarity between the two eastern phylogeographical groups. This, together with other lines of evidence, is interpreted as an indication for colonization of the eastern part of the distributional range of A. alpina from westerly adjacent populations. The phylogeographical groups can all be related to potential refugia for alpine plants, based on geological and palaeoclimatological data. However, due to the comparatively weak phylogeographical structure, our data do not allow us to rule out glacial survival on nunataks in central parts of the Pleistocene ice shield.
Reinstatement of Chiastocaulon Carl (Plagiochilaceae), Based on Evidence from Nuclear Ribosomal ITS and Chloroplast Gene rps4 Sequences
Authors: Groth H. , Heinrichs J.
Published: February 2004

Abstract: Morphological approaches have led to controversial opinions regarding the systematic position of the Asian Jungermannia dendroides Nees within the family Plagiochilaceae. In recent times, the taxon was treated both as genus Chiastocaulon Carl, as a member of Plagiochila sect. Dendroideae Gottsche, Lindenb. and Nees, and as a representative of Plagiochila subgen. Chiastocaulon (Carl) Inoue. Sequences of the chloroplast‐encoded rps4 gene and the internal transcribed spacers of nuclear ribosomal DNA of 28 representatives of the Plagiochilaceae and Herbertus subdentatus (Herbertaceae, outgroup) were obtained to test the different hypotheses. Maximum likelihood analyses were performed, both on the separate and combined data sets, and in all cases resulted in a single optimal topology. The different phylogenies were congruent, but the analyses of the combined data set led to an overall more significant bootstrap support. Jungermannia dendroides was placed in a moderately supported clade with Pedinophyllum interruptum and Plagiochilion mayebarae, sister to the well supported Plagiochila clade. The topology justifies the recognition of Jungermannia dendroides as genus Chiastocaulon. Plagiochila frondescens (Nees) Lindenb., P. fruticosa Mitt. and P. pulcherrima Horik., placed alongside Chiastocaulon/Plagiochila dendroides by some authors, form a robust clade within Plagiochila (Dumort.) Dumort., assignable to P. sect. Fruticosae Inoue. The three species share the dendroid habit and alternating foliation with Chiastocaulon dendroides but lack well developed ventral intercalary branches. 11 sectional clades with robust bootstrap support were identified within the Plagiochila lineage. Many morphological characters of monophyletic lineages within the Plagiochilaceae appeared homoplastic, indicating that a natural subdivision of the family is only possible by the integration of molecular data. The molecular topologies justify a hierarchical subdivision of Plagiochila at some point in the future; however, well supported sectional groups of the molecular trees will presumably lack morphological autapomorphisms.
Pollination of Nymphaea lotus (Nymphaeaceae) by Rhinoceros Beetles and Bees in the Northeastern Ivory Coast
Authors: Hirthe G. , Porembski S.
Published: February 2004

Abstract: Detailed observations of the pollination biology of Nymphaea lotus were conducted by studying populations growing in seasonal ponds in the Comoé National Park (NE Ivory Coast). Flowers of N. lotus are protogynous and anthesis lasts for 4 to 5 days. Flowers open at sunset and close in the morning hours, thereby revealing a high variability in timing. For the first time, heat production in flowers could be observed in the genus Nymphaea. Flowers of N. lotus were visited by Ruteloryctes morio, an endemic dynastid beetle during the night. Beetles copulated in the flowers and fed on flower parts, but were less effective pollinators than several bee species that visited flowers in the early morning. Nymphaea lotus thus seems to be adapted to pollination by both nocturnal beetles and diurnal bees.
Under- and overreporting of energy is related to obesity, lifestyle factors and food group intakes in Jamaican adults
Authors: Mendez Michelle A , Wynter Suzanne , Wilks Rainford , Forrester Terrence
Published: January 2004

Objective:

Research in industrialised countries has documented a high prevalence of underreported energy intakes associated with characteristics such as obesity. This paper examines the prevalence, patterns and impact of energy under- and overreporting on diet–obesity relationships in a middle-income developing country.

Design:

A 70-item food-frequency questionnaire was used. Underreporters had reported energy intakes < 1.35 × basal metabolic rate (BMR), overreporters > 2.4 × BMR. Multinomial models were used to identify characteristics associated with implausible reporting. Intakes were compared across reporting groups to assess evidence of bias. Associations between diet and obesity were compared with and without adjustment for implausible reporting.

Setting:

Spanish Town, neighbouring the capital city of Kingston, Jamaica.

Subjects:

Eight hundred and ninety-one Jamaican adults, aged 25–75 years, were randomly recruited.

Results:

More women than men (38.6% vs. 22.5%) underreported, but more men overreported energy (23.7% vs. 16.0%). Underreporting was positively associated with obesity, special diets, smoking and age; age was inversely associated with overreporting. Underreporters estimated lower energy from potentially socially undesirable food groups (e.g. snacks) and higher intakes of ‘healthy’ foods (e.g. fruit) than did plausible reporters. For some of these food groups, significant differences in intakes among normal-weight versus obese subjects observed among plausible reporters were absent when implausible reporters were included. In models of food group–obesity associations, adjusting for implausible energy yielded more credible results that more closely resembled findings in plausible reporters.

Conclusions:

Energy under- and overreporting are highly prevalent in Jamaica. Adjusting for implausible reporting may help to reduce bias in diet–health outcome associations.
Having lunch at a staff canteen is associated with recommended food habits
Authors: Roos Eva , Sarlio-Lähteenkorva Sirpa , Lallukka Tea
Published: January 2004

Objective:

To describe the characteristics of employees having lunch at staff canteens and to examine the association between workplace lunch and recommended food habits.

Design:

A mailed questionnaire including data on lunch pattern, food habits, sociodemographic background, work-related factors and body weight. Logistic regression models including food habits as dependent variables and lunch pattern, sociodemographic factors, work-related factors and body mass index as independent variables.

Setting:

Helsinki Health Study survey data, collected in spring 2001.

Subjects:

Employees from the City of Helsinki reaching 40, 45, 50, 55 and 60 years. The data included 2474 women and 591 men; the response rate was 68%.

Results:

About half of those with a staff canteen at work had lunch there. Those with higher educational level were more likely to have lunch at the staff canteen, as also were women with pre-school children and normal-weight men. Those having lunch at staff canteens were more likely to follow recommended food habits, compared with other subjects. Having lunch at the staff canteen seemed to increase the consumption frequency of vegetables and fish.

Conclusions:

Having lunch at staff canteens is associated with the quality of the diet. To serve a cooked meal including vegetables during working time may be an efficient way to improve diet among adult employees. More emphasis should be put on increasing the possibility for employees to have lunch at staff canteens.
Energy-dense diets are associated with lower diet costs: a community study of French adults
Authors: Darmon Nicole , Briend André , Drewnowski Adam
Published: January 2004

Objective:

High consumption of energy-dense foods has been linked to high energy intakes and excess weight gain. This study tested the hypothesis that high energy density of the total diet is associated with lower diet costs.

Design:

Dietary intakes of 837 French adults, aged 18–76 years, were assessed using a dietary history method. Dietary energy density (MJ kg−1) was calculated by dividing total energy by the edible weight of foods consumed. Daily diet cost (€day−1) was estimated using mean national food prices for 57 food items. The relationship between dietary energy density and diet cost at each level of energy intake was examined in a regression model, adjusted for gender and age.

Results:

The more energy-dense refined grains, sweets and fats provided energy at a lower cost than did lean meats, vegetables and fruit. Within each quintile of energy intake, diets of lower energy density (MJ kg−1) were associated with higher diet costs (€day−1).

Conclusion:

In this observational study, energy-dense diets cost less whereas energy-dilute diets cost more, adjusting for energy intakes. The finding that energy-dilute diets are associated with higher diet costs has implications for dietary guidelines and current strategies for dietary change.
Determinants of diet quality
Authors: Thiele Silke , Mensink Gert BM , Beitz Roma
Published: January 2004

Background:

An unbalanced diet is a main risk factor for several chronic diseases. This paper identifies groups of individuals with an unbalanced diet based on the consumption of nutrients. A characterisation of the groups may help to focus efforts aimed at improving the dietary behaviour of the population.

Methods:

Using nutritional data of 1763 men and 2267 women participating in the German Nutrition Survey of 1998, we constructed two indices for diet quality that each combines a large amount of nutrients into a single indicator. The impact of sociodemographic and lifestyle characteristics on the diet quality indices was analysed using multiple regression analyses.

Results:

The results show a considerable variation of diet quality between different groups of individuals. High diet quality in terms of the consumption of vitamins, minerals and trace elements is positively associated with income, education level, age, energy intake, food diversity, sport activity and vegetarianism. On the other hand, a low diet quality as indicated by high intakes of e.g. fat, sugar, alcohol and sodium can be expected when energy intake is high, for individuals of middle age and for pregnant and breast-feeding women.

Conclusion:

The results of this study help to identify groups of individuals with preferable and non-preferable diet quality. For developing public health strategies, in particular the impact of age on diet quality seems to be interesting. The rising diet quality with increasing age could reflect a changing health consciousness. It could thus be a challenge for health policy to promote a healthy way of living focused especially on young individuals.
Assessment of the nutritional risk of > 53-year-old men and women in Taiwan
Authors: Tsai Alan C , Chang Jack MC , Lin Harvey , Chuang Yi-Li , Lin Shu-Hui , Lin Yu-Hsuan
Published: January 2004

Objective:

The study was conducted to gain an understanding of the status of potential nutrition risks in > 53-year-old men and women in Taiwan.

Methods:

The study employed a validated nutrition-risk screening questionnaire, the Mini Nutritional Assessment, to assess the potential risk of undernutrition in the elderly population in Taiwan. The questionnaire was translated into the local language, Chinese, and was modified slightly based on cultural considerations. It was administered to 4440 randomly selected subjects by means of face-to-face interviews. The questionnaire included questions on subjective self-evaluations, global parameters, simple dietary assessment and some anthropometric measurements.

Results:

Results show that the questionnaire can be used effectively as a tool to screen for individuals who are at risk of undernutrition. It showed that the proportion of the elderly population at risk of nutritional inadequacy is relatively low, but does increase with advanced ageing. The proportion of the elderly considered at high risk of undernutrition was found to increase with age, ranging from 0.88% for 53–60-year-old subjects to 1.86% for subjects aged 60–70 years, 3.6% for 70–80-year-olds and 5.3% for >80-year-old subjects.

Conclusion:

The study showed that a simple questionnaire adopted from the Mini Nutritional Assessment can be employed to provide a preliminary screening and to identify individuals who are potentially at increased risk of nutritional inadequacy in the elderly population in Taiwan.
Distinct roles of MLCK and ROCK in the regulation of membrane protrusions and focal adhesion dynamics during cell migration of fibroblasts
Authors: Totsukawa Go , Wu Yue , Sasaki Yasuharu , Hartshorne David J. , Yamakita Yoshihiko , Yamashiro Shigeko , Matsumura Fumio
Published: February 2004

We examined the role of regulatory myosin light chain (MLC) phosphorylation of myosin II in cell migration of fibroblasts. Myosin light chain kinase (MLCK) inhibition blocked MLC phosphorylation at the cell periphery, but not in the center. MLCK-inhibited cells did not assemble zyxin-containing adhesions at the periphery, but maintained focal adhesions in the center. They generated membrane protrusions all around the cell, turned more frequently, and migrated less effectively. In contrast, Rho-associated kinase (ROCK) inhibition blocked MLC phosphorylation in the center, but not at the periphery. ROCK-inhibited cells assembled zyxin-containing adhesions at the periphery, but not focal adhesions in the center. They moved faster and more straight. On the other hand, inhibition of myosin phosphatase increased MLC phosphorylation and blocked peripheral membrane ruffling, as well as turnover of focal adhesions and cell migration. Our results suggest that myosin II activated by MLCK at the cell periphery controls membrane ruffling, and that the spatial regulation of MLC phosphorylation plays critical roles in controlling cell migration of fibroblasts.
A novel LIM protein Cal promotes cardiac differentiation by association with CSX/NKX2-5
Authors: Akazawa Hiroshi , Kudoh Sumiyo , Mochizuki Naoki , Takekoshi Noboru , Takano Hiroyuki , Nagai Toshio , Komuro Issei
Published: February 2004

The cardiac homeobox transcription factor CSX/NKX2-5 plays an important role in vertebrate heart development. Using a yeast two-hybrid screening, we identified a novel LIM domain–containing protein, named CSX-associated LIM protein (Cal), that interacts with CSX/NKX2-5. CSX/NKX2-5 and Cal associate with each other both in vivo and in vitro, and the LIM domains of Cal and the homeodomain of CSX/NKX2-5 were necessary for mutual binding. Cal itself possessed the transcription-promoting activity, and cotransfection of Cal enhanced CSX/NKX2-5–induced activation of atrial natriuretic peptide gene promoter. Cal contained a functional nuclear export signal and shuttled from the cytoplasm into the nucleus in response to calcium. Accumulation of Cal in the nucleus of P19CL6 cells promoted myocardial cell differentiation accompanied by increased expression levels of the target genes of CSX/NKX2-5. These results suggest that a novel LIM protein Cal induces cardiomyocyte differentiation through its dynamic intracellular shuttling and association with CSX/NKX2-5.
Oxidative protein folding in eukaryotes
Authors: Tu Benjamin P. , Weissman Jonathan S.
Published: February 2004

The endoplasmic reticulum (ER) provides an environment that is highly optimized for oxidative protein folding. Rather than relying on small molecule oxidants like glutathione, it is now clear that disulfide formation is driven by a protein relay involving Ero1, a novel conserved FAD-dependent enzyme, and protein disulfide isomerase (PDI); Ero1 is oxidized by molecular oxygen and in turn acts as a specific oxidant of PDI, which then directly oxidizes disulfide bonds in folding proteins. While providing a robust driving force for disulfide formation, the use of molecular oxygen as the terminal electron acceptor can lead to oxidative stress through the production of reactive oxygen species and oxidized glutathione. How Ero1p distinguishes between the many different PDI-related proteins and how the cell minimizes the effects of oxidative damage from Ero1 remain important open questions.
Pathogenic Profiles and Molecular Signatures of Antinuclear Autoantibodies Rescued from NZM2410 Lupus Mice
Authors: Liang Zhiyan , Xie Chun , Chen Cui , Kreska Desi , Hsu Kelvin , Li Liunan , Zhou Xin J. , Mohan Chandra
Published: February 2004

Two outstanding questions concerning antinuclear antibodies (ANAs) in lupus involve their pathogenic potential and their molecular signatures. To address these questions, a panel of 56 antinuclear and 47 nonnuclear binding monoclonal antibodies was rescued from four seropositive NZM2410 lupus mice. The monoclonals varied in their reactivity to nucleosomes, ssDNA, dsDNA, and glomerular substrate. A large fraction of the antibodies demonstrated apparent polyreactivity (to DNA, histones, and glomerular antigens) due to bound, DNase-1 sensitive nuclear antigenic bridges. Although nephrophilic immunoglobulin (Ig) M and IgG antibodies were the most pathogenic, the dsDNA-binding antibodies were modestly so; in contrast, antinucleosome antibodies were clearly not pathogenic. Compared with the nonnuclear antigen-binding monoclonal antibodies rescued from the same mice, ANAs exhibited increased utilization of VH5/7183 genes and highly cationic heavy chain (HC) CDR3 regions. Most intriguingly, the CDR3 regions of the ANAs exhibited alternating arginine/lysine peaks at H96, H98, and H100, with neutral troughs at H95, H97, and H99. To summarize, glomerular-binding anti-dsDNA antibodies appear to be the most pathogenic variety of lupus autoantibodies. The presence of an alternating charge pattern in their HC CDR3 regions appears to be a prominent hallmark of ANAs.
WIP Regulates Signaling via the High Affinity Receptor for Immunoglobulin E in Mast Cells
Authors: Kettner Alexander , Kumar Lalit , Antón Inés M. , Sasahara Yoji , de la Fuente Miguel , Pivniouk Vadim I. , Falet Hervé , Hartwig John H. , Geha Raif S.
Published: February 2004

Wiskott-Aldrich syndrome protein–interacting protein (WIP) stabilizes actin filaments and is important for immunoreceptor-mediated signal transduction leading to actin cytoskeleton rearrangement in T and B cells. Here we report a role for WIP in signaling pathways downstream of the high affinity receptor for immunoglobulin (Ig)E (FcϵRI) in mast cells. WIP-deficient bone marrow–derived mast cells (BMMCs) were impaired in their capacity to degranulate and secrete interleukin 6 after FcϵRI ligation. Calcium mobilization, phosphorylation of Syk, phospholipase C-g2, and c-Jun NH2-terminal kinase were markedly decreased in WIP-deficient BMMCs. WIP was found to associate with Syk after FcϵRI ligation and to inhibit Syk degradation as evidenced by markedly diminished Syk levels in WIP-deficient BMMCs. WIP-deficient BMMCs exhibited no apparent defect in their subcortical actin network and were normal in their ability to form protrusions when exposed to an IgE-coated surface. However, the kinetics of actin changes and the cell shape changes that follow FcϵRI signaling were altered in WIP-deficient BMMCs. These results suggest that WIP regulates FcϵRI-mediated mast cell activation by regulating Syk levels and actin cytoskeleton rearrangement.
Party System Compactness: Measurement and Consequences
Authors: Alvarez R. Michael , Nagler Jonathan
Published: February 2004

An important property of any party system is the set of choices it presents to the electorate. In this paper we analyze the distribution of parties relative to voters in the multidimensional issue space and introduce two measures of the dispersion of the parties in the issue space relative to the voters, which we call measures of the compactness of the parties in the issue space. We show how compactness is easily computed using standard survey items found on national election surveys. Because we study the spacing of the parties relative to the distribution of the voters, we produce metric-free measures of compactness of the party system. The measures can be used to compare party systems across issues, over time within countries, and across countries. Comparing the compactness of party systems across countries allows us to determine the relative amount of issue choice afforded voters in different polities. We examine the compactness of the issue space and test the impact it has on voter choice in four countries: the United States, the Netherlands, Canada, and Great Britain. We demonstrate that the more compact the distribution of the parties in the issue space on any given issue, the less voters weight that issue in their vote decision. Thus we provide evidence supporting theories suggesting that the greater the choice offered by the parties in an election, the more likely it is that issue voting will play a major role in that election.
Use of the 70‐Degree Diamond Burr in the Management of Complicated Frontal Sinus Disease
Authors: Chandra Rakesh K. , Schlosser Rodney , Kennedy David W.
Published: January 2004

Objectives/Hypothesis: Management of frontal sinus disease may require drill‐out of bone in the frontal recess for access, ventilation, and drainage of the sinus cavity; removal of osteitic foci; or resection of neoplastic tissue. Technological advances, particularly burrs with angles of 70 degrees and stereotactic navigational imaging, offer new opportunities to provide access and minimize trauma. The preliminary study evaluates the safety and efficacy of such minimally invasive approaches.

Study Design: Retrospective review.

Methods: The authors describe the use of a 70‐degree diamond burr in a series of 10 patients with complicated frontal sinus disease who underwent endoscopic frontal sinusotomy under stereotactic imaging guidance.

Results: The diagnoses consisted of frontal sinus mucocele (n = 4), chronic frontal sinusitis (n = 1), Pott's puffy tumor after frontoethmoid fracture (n = 1), and recurrent inverting papilloma (n = 4). Partial septectomy was required in 6 of 10 patients. No complications were attributable to the drill‐out procedure, despite a pre‐existing frontoethmoid bony dehiscence in 6 of 10 patients. One patient had a CSF leak during removal of tumor from the skull base. One patient required revision frontal sinusotomy 10 months after the initial procedure, and another required further surgery for residual inverting papilloma on the medial orbital wall. All frontal sinusotomies were patent at last follow‐up (mean period, 9.3 mo).

Conclusion: Extended endoscopic frontal sinusotomy may be necessary in the management of complicated frontal sinus inflammatory disease and inverting papilloma. The 70‐degree diamond burr is a safe and effective tool for access to the frontal recess. Complication rates appear to be similar to those for other extended frontal sinusotomy approaches.
Propofol Decreases Waste Anesthetic Gas Exposure During Pediatric Bronchoscopy
Authors: Zestos Maria M. , Bhattacharya Debashish , Rajan Sankar , Kemper Sharon , Haupert Michael
Published: January 2004

Objective: This study compared the anesthetic gas exposure and operating conditions during insufflation anesthesia with halothane‐alone versus halothane‐propofol in children undergoing direct laryngobronchoscopy.

Study Design: Forty‐six children were enrolled in this randomized prospective study, with institutional review board approval and informed consent.

Methods: All children were anesthetized by halothane mask induction and anesthesia was maintained using spontaneous ventilation with insufflation. No muscle relaxants or opioids were used. In the halothane group, halothane was titrated as needed. In the propofol group, halothane was decreased to 1% inspired concentration and the propofol was titrated as needed to maintain spontaneous ventilation and a still patient. Trace anesthetic gases, hemodynamic stability, and operating conditions were measured.

Results: The groups were similar in age, weight, and bronchoscopy time. There was significantly less gas exposure in the propofol group (25 ± 33 parts per million) versus the halothane group (66 ± 97 ppm; P < .02). There was a trend toward earlier emergence in the halothane group (33 ± 13 minutes) versus the propofol group (41 ± 17 minutes). Postoperative stridor was common, occurring in 30% of children.

Conclusions: Insufflation anesthesia with spontaneous respiration provides excellent surgical conditions for laryngobronchoscopy. The addition of propofol resulted in fewer airway complications (P = .047). Although the addition of propofol significantly decreased anesthetic gas exposure in the operating room, both techniques resulted in operating room pollution that exceeded the maximum levels of 2 ppm per hour recommended by the US National Institute for Occupational Safety and Health (NIOSH).
Vestibular Nerve Section Versus Intratympanic Gentamicin for Meniere's Disease
Authors: Hillman Todd A. , Chen Douglas A. , Arriaga Moises A.
Published: January 2004

Objectives/Hypothesis:Vestibular nerve section and transtympanic gentamicin administration are procedures with proven efficacy in the treatment of vertigo associated with Meniere's disease refractory to medical management. Hearing loss is a known complication of each of these procedures; however, there has not been a report of hearing results of both treatments from a single institution.

Study Design:Retrospective review.

Methods:Review was made of 25 patients undergoing gentamicin injection and 39 patients undergoing vestibular nerve section for Meniere's disease. Rate of vertigo control and pretreatment and post‐treatment pure‐tone average values and speech discrimination scores were reported.

Results:The mean preoperative pure‐tone average for patients having vestibular nerve section was 47.2 dB, with a speech discrimination score of 75.4%. In these patients, the postoperative pure‐tone average was 49.1 dB and the speech discrimination score was 75%. Patients undergoing gentamicin injection had a mean pretreatment pure‐tone average of 55.9 dB and a speech discrimination score of 62%. The post‐treatment pure‐tone average and speech discrimination score for the gentamicin group were 68.8 dB and 49.3%, respectively. Five of 25 patients (20%) in the gentamicin treatment group and 1 of 39 (3%) in the vestibular nerve section treatment group had an increase in bone‐conduction threshold greater than 30 dB. The amount of postprocedure hearing loss was significantly greater in the gentamicin treatment group (P = .006). Control of vertigo was good to excellent in 95% of the patients treated with vestibular nerve section and in 80% of the patients treated with gentamicin.

Conclusion:Although vestibular nerve section and transtympanic gentamicin are both acceptable treatment options for vertigo associated with Meniere's disease, gentamicin causes a higher level of hearing loss related to treatment and vestibular nerve section has higher vertigo control rates.
Functional Outcome After Total Parotidectomy Reconstruction
Authors: Fee Willard E. , Tran Lynn E.
Published: January 2004

Objectives/Hypothesis: The objective was to compare and contrast the functional and cosmetic outcomes of patients who underwent total parotidectomy with and without reconstruction using an inferiorly based sternocleidomastoid muscle flap.

Study Design: Retrospective review in the setting of a university medical center.

Methods: Twenty‐four patients underwent a total parotidectomy. Fifteen patients had reconstruction with an inferiorly based sternocleidomastoid muscle flap, and nine patients had no reconstruction. Clinical examination was performed independently by two head and neck surgeons and one aesthetician to evaluate cosmetic outcome, presence of gustatory flushing or sweating, and return of facial nerve and greater auricular nerve function.

Results: With the mean follow‐up of 22 months, the group having reconstruction showed a better cosmetic outcome compared with the group without reconstruction. Objective testing for Frey syndrome demonstrated gustatory sweating in 20% of the group having reconstruction group versus 22% in the group without reconstruction. There was no difference in length of operation, hospital stay, or facial nerve function. Objective testing of facial sensation revealed that only 40% in the group having reconstruction had normal sensation to light touch compared with 78% in the group without reconstruction.

Conclusion: The inferiorly based sternocleidomastoid muscle flap offers improved cosmetic results in patients undergoing total parotidectomy. However, there is a decreased return of greater auricular nerve function, probably attributable to relocation of the nerve stump anteriorly. Benefit was not seen in prevention of Frey syndrome measured objectively; however, the group having reconstruction had fewer clinical symptoms of gustatory sweating or flushing.
The Diagnostic Utility of Computed Tomography for Preoperative Localization in Surgery for Hyperparathyroidism
Authors: Gross Neil D. , Weissman Jane L. , Veenker Elizabeth , Cohen James I.
Published: January 2004

Objectives/Hypothesis: Successful unilateral or minimal‐access parathyroid exploration and reoperative surgery of the parathyroid glands requires accurate preoperative localization of parathyroid disease. Although ultrasound and nuclear imaging techniques have an established role in this regard, the use of computed tomography (CT) for parathyroid exploration is not well understood. The purpose of the present study was to better define the diagnostic utility of CT in preoperative localization of the abnormal gland in surgery for hyperparathyroidism.

Study Design: Retrospective cohort study.

Methods: All parathyroid explorations performed at Oregon Health and Science University (Portland, OR) between 2000 and 2002 were reviewed. The study group was limited to patients with hyperparathyroidism in whom localization failed preoperatively using ultrasound and/or sestamibi scanning and subsequent investigation using CT imaging was performed. Operative, pathological, and imaging reports were then analyzed to assess the accuracy of CT imaging for localizing parathyroid disease.

Results: Twenty‐two patients with hyperparathyroidism were investigated preoperatively using CT imaging. Parathyroid exploration was successful in all but one patient, leaving 21 patients in all in the cohort. The majority of cases (67%) were reoperative, and all patients had previously undergone inconclusive ultrasound and/or sestamibi scanning. Computed tomography correctly localized parathyroid disease in 18 (86%) of the 21 patients who underwent successful extirpation of parathyroid disease and was able to identify abnormal glands with equal utility in the neck and the chest.

Conclusion: When ultrasound or sestamibi are unsuccessful, CT imaging can provide valuable preoperative localizing information before surgery for hyperparathyroidism, particularly in patients with recurrent or persistent disease.
Role of the Physician Versus the Patient in the Detection of Recurrent Disease Following Treatment for Head and Neck Cancer
Authors: Agrawal Amit , deSilva Brad W. , Buckley Brooke M. , Schuller David E.
Published: January 2004

Objectives/Hypothesis: Objective evidence supporting current National Comprehensive Cancer Network guidelines regarding surveillance of patients treated for head and neck cancer is presently lacking. The study examines the relative role of current surveillance methods on disease detection in this patient population.

Study Design: Prospective nonrandomized study.

Methods: Clinical information was prospectively collected in a standardized format during 3645 encounters with patients with head and neck cancer over an 18‐month period. Data pertaining to visit history, symptom history, patient findings, physician findings, and disease status for each encounter were reviewed.

Results: Of 3645 visits, disease recurrence or new primary tumor was documented in 180 encounters (5%). Salvage therapy was thought to be feasible in at least 65% of cases. Of these 180 recurrences or new primaries, there were 142 patients (79%) who had identified new symptoms or physical findings, or both, before the physician's examination. Most commonly reported was the presence of a neck mass (38%), progressive pain (27%), or other visible lesion or ulcer (14%). Patients with recurrence represented nearly 40% of all patients reporting new symptoms or findings (142 of 367). Conversely, recurrence was rare in the absence of reported symptoms or findings (1.2%). Surprisingly, despite patients reporting new symptoms or findings, physician evaluation most commonly occurred at the patient's routine surveillance visit rather than an earlier time point (104 of 142 [73%]).

Conclusion: Self‐diagnosis of recurrent or new primary disease is extremely common by virtue of symptoms or findings noted by patients before interaction with the clinician. However, presence of symptoms or findings did not motivate the patients to seek earlier medical attention. In the absence of such symptoms, physician diagnosis of recurrence is uncommon. Given the significant social and economic impact involved in surveillance of patients with head and neck cancer, further prospective study to optimize the method and frequency of this type of clinical activity is warranted and planned.
Nasal Cerebrospinal Fluid Leaks: Critical Review and Surgical Considerations
Authors: Schlosser Rodney J. , Bolger William E.
Published: January 2004

Otolaryngologists have assumed a major role in the evaluation and management of anterior skull base defects that result in cerebrospinal fluid (CSF) leaks and meningoencephaloceles. To achieve the best possible results for patients with CSF leaks, a thorough understanding of the underlying pathophysiology and a critical analysis of management principles and treatment options is essential. Surgical and medical management of these patients is highly individualized and depends on a number of factors, including etiology, anatomic site, patient age, and underlying intracranial pressure. This review article will highlight the history, physiology, pathophysiology, diagnosis, surgical techniques, and postoperative care relevant to nasal CSF leaks and encephaloceles.
Use of Sodium Fluorescein Solution for Detection of Cerebrospinal Fluid Fistulas: An Analysis of 420 Administrations and Reported Complications in Europe and the United States
Authors: Keerl Rainer , Weber Rainer K. , Draf Wolfgang , Wienke A , Schaefer Steven D.
Published: January 2004

Background: Localization of dural fistulas in the region of the anterior or lateral skull base may be difficult. For many years, a sodium fluorescein solution of 0.5 to 5% (2.5–50 mg) has been administered intrathecally by way of the lumbar space. However, fluorescein is not commercially available for this stated purpose in either Germany or the United States.

Methods: Retrospectively, 420 fluorescein applications by the authors were retrospectively analyzed. Under the Freedom of Information Act, the United States Federal Drug Administration and the manufactures of fluorescein were queried for adverse reaction reports.

Results: Four hundred twenty fluorescein applications in 305 patients could be evaluated. Mean age of recipients was 46.9 years, ranging from 1 to 82 years. At a concentration of 5% fluorescein, 26 patients on the day of surgery and 69, 37, 34, and 14 patients on days 2 through 4 suffered from minor side effects that may or may not have been related to this drug. Two of these patients had grand mal seizures, which were attributable to simultaneous intrathecal application of contrast medium. All other side effects were thought to be the result of a postspinal headache and related lumbar puncture. At a concentration of 0.5%, the intraoperative intrathecal administration of 0.5 to 2 mL of fluorescein followed by 4 to 5 days of lumbar drainage resulted in some degree of spinal headache without other complications. In both groups, no patient had sequelae longer than 4 weeks. An additional seven complications were reported to the Federal Drug Administration and the fluorescein manufacturers at doses of 100 to 700 mg.

Conclusions: Complications from intrathecal application of fluorescein appears to be dose dependent. At concentrations of 5%, or preferably lower, side effects are transient. A grand mal seizure can be minimized when following the general cautions of lumbar puncture and dose. The patient should be supervised for 24 hours. A written informed consent from patients for use of fluorescein is recommended.
Pathology of the Olfactory Mucosa: Implications for the Treatment of Olfactory Dysfunction
Authors: Kern R C , Conley D B , Haines G K , Robinson A M
Published: January 2004

Objective: The pathology of the olfactory mucosa is poorly understood; however, most cases of hyposmia and anosmia appear to be associated with a decline in the number of functioning mature olfactory sensory neurons (OSNs). Under normal conditions, OSNs undergo apoptotic cell death at a baseline rate likely secondary to their exposed location in the nose. Regeneration of mature OSNs from precursors in the epithelium allows the animal to maintain an adequate number of neurons necessary for olfactory sensation. In many cases of olfactory dysfunction, this balance is apparently disturbed, with a net loss of OSNs. The current study will examine normal and diseased olfactory tissue for the presence of data demonstrating that the preferred mechanism of OSN cell death is apoptotic in both health and disease. The potential therapeutic implications will be discussed.

Study Design: Histologic analysis of human and animal olfactory tissue.

Methods: Normal and diseased human and animal olfactory mucosa were assessed for immunohistochemical evidence of apoptosis.

Results: Increased activity of the apoptotic effector enzyme caspase‐3 was demonstrated in diseased olfactory mucosa in comparison with normal controls.

Conclusion: These results indicate that a common pathway may mediate OSN cell death from a diverse set of pathologic insults including aging, trauma, and sinusitis. Interference with this pathway of cell death is currently the subject of intense pharmacotherapeutic research for the management of stroke and meningitis. These drugs may ultimately prove useful in the treatment of clinical olfactory dysfunction.
The Effect of Electrocautery Versus Cold Scalpel Technique on the Incidence of Early Postoperative Tonsillar Pillar Dehiscence After Uvulopalatopharyngoplasty With Tonsillectomy
Authors: Altman Jerald S. , Senior Brent , Ransom Elizabeth
Published: January 2004

Objectives/Hypothesis: The objective was to determine the effect of electrocautery versus cold scalpel technique on the incidence of early postoperative tonsillar pillar dehiscence after uvulopalatopharyngoplasty with tonsillectomy.

Study Design: Prospective, randomized, matched‐pair trial of patients undergoing uvulopalatopharyngoplasty with tonsillectomy.

Methods: Patients undergoing uvulopalatopharyngoplasty with tonsillectomy were randomly assigned to have the procedure performed with cold scalpel technique or with electrocautery. Thirty‐three patients were enrolled. Twenty‐seven patients returned for postoperative evaluation.

Results: The overall incidence of tonsillar pillar dehiscence was 38.8%. The incidence of dehiscence was 44.4% in the electrocautery group and 33.3% in the cold dissection group.

Conclusion: Preliminary data suggest that the use of electrocautery is not associated with an increase incidence of wound dehiscence compared with cold dissection. Tonsillar pillar dehiscence rate is high, regardless of dissection method.
Complications of Microdebrider‐Assisted Powered Intracapsular Tonsillectomy and Adenoidectomy
Authors: Sorin Alexander , Bent John P. , April Max M. , Ward Robert F.
Published: January 2004

Objectives: To study complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatric patients with obstructive sleep apnea (OSA).

Study Design: Retrospective chart review and long‐term follow‐up in office or by telephone interview.

Methods: We studied 278 patients who underwent PITA between September 2000 and October 2002. Outcome measures were postoperative bleeding, velopharyngeal insufficiency, need for hospital readmission, tonsil regrowth, and return of snoring or sleep apnea symptoms.

Results: All 278 children treated by PITA had immediate resolution of symptoms of OSA. Complications were noted in 11 patients (3.9%). Nine patients (3.2%) experienced tonsil regrowth with snoring, two of whom evolved to a return of OSA that was definitively managed by means of a complete tonsillectomy. Two patients (0.7%) had selflimited bleeding. None of the patients developed persistent velopharyngeal insufficiency or required hospital readmission.

Conclusions: Microdebriderassisted PITA is a safe and effective alternative for children otherwise treated with traditional tonsillectomy for symptoms of OSA due to adenotonsillar hypertrophy. This series suggests a 3.9% overall rate of complications, with the most common noted as tonsillar regrowth without recurrence of OSA. Prospective trials with longer follow‐up may define higher complication rates.