bluuebunny/crossref_metadata_2025 huggingface dataset:
Palifermin in a hematopoietic stem cell transplant patient with osteonecrosis of the jaw
Authors: Yageman Leah A , Cronin Simon M , Peres Edward , Abidi Muneer H , Ibrahim Rami B
Published: October 2006

This case report describes the use of palifermin in a multiple myeloma patient with a history of osteonecrosis of the jaw (ONJ) for the prevention of high-dose chemotherapy-induced mucositis. Following the day of autologous stem cell infusion, palifermin was discontinued secondary to adverse events. Specifically, palifermin-associated macroglossia seemed to exacerbate the pain localized in the oral cavity area affected by ONJ, necessitating escalated doses of narcotic analgesics. When contemplating palifermin as a mucosal protectant in a hematopoietic stem cell transplant patient with ONJ, a careful benefit-to-risk assessment is in order to ensure optimal effectiveness without undue harm.
Innovations in Health Care Delivery: Response to Global Nurse Migration—An Education Example
Authors: Lebold Mary M. , Walsh Catherine D.
Published: October 2006

Internationally educated nurses who have not yet met the requirements for registered nurse (RN) licensure represent an unrecognized resource during a time of severe nursing shortage. This article describes the efforts of the Chicago Bilingual Nurse Consortium (CBNC), a collaborative partnership developed to provide education, advocacy, and support services to these nurses.
The Impact of Nurse Turnover on Patient, Nurse, and System Outcomes: A Pilot Study and Focus for a Multicenter International Study
Authors: O’Brien-Pallas Linda , Griffin Pat , Shamian Judith , Buchan James , Duffield Christine , Hughes Frances , Laschinger Heather K. Spence , North Nicola , Stone Patricia W.
Published: October 2006

Research about the economic impact of nurse turnover has been compromised by a lack of consistent definitions and measurement. This article describes a study that was designed to refine a methodology to examine the costs associated with nurse turnover. Nursing unit managers responded to a survey that contained items relating to budgeted full-time equivalents, new hires, and turnover, as well as direct and indirect costs. The highest mean direct cost was incurred through temporary replacements, whereas the highest indirect cost was decreased initial productivity of the new hire. The study allowed the identification of the availability of data and where further refinement of data definition of variables is needed. The results provided significant evidence to justify increased emphasis on nurse retention strategies and the creation of healthy work environments for nurses.
In-Country Challenges to Addressing the Effects of Emerging Global Nurse Migration on Health Care Delivery
Authors: Jeans Mary Ellen
Published: October 2006

An integrated approach is necessary to address the ethical, cultural, and safety issues raised by international nurse migration into Canada. A recent federally funded study yielded important information regarding gaps in regulation, screening, assessment, and registration of internationally educated nurses. A series of recommendations have emerged from this important study.
Health Services Delivery: Reframing Policies for Global Migration of Nurses and Physicians—A U.S. Perspective
Authors: Cooper Richard A. , Aiken Linda H.
Published: October 2006

One half of all of the nurses and physicians in English-speaking countries practice in the United States, yet future shortages of both professions are projected. Because the United States has failed to create sufficient educational capacity for its own needs, it is dependent on foreign health professionals. The magnitude of this dependency has a significant impact on the health care systems of source countries, particularly developing countries, from which the majority of foreign nurses and physicians coming to the United States emigrate. Even emigration from the United Kingdom and other developed countries affects developing countries because it triggers recruitment from developing countries to replace this emigration. To achieve a higher level of self-sufficiency, the United States must establish a national health care workforce policy that gives priority to building adequate educational infrastructure, while also providing assistance to developing countries to train and retain adequate numbers of health professionals.
Innovations in Health Care Delivery: Responses to Global Nurse Migration—A Research Example
Authors: O’Brien-Pallas Linda , Wang Sping
Published: October 2006

Using data from a large survey of Canadian nurses, we examined how internationally born nurses (IBNs) in Canada experience their work environment. There are significant differences in demographics and in work status and practice environment. Significantly more IBNs are members of visible minorities than are their Canadian-born counterparts. IBNs work more hours, including more overtime, and are more likely to experience physician, verbal, and emotional abuse. Self-rated health status was worse for IBNs in physical and mental health. Changes are needed to improve the nursing work environment and nurses’ perception of the effectiveness of care, and to improve their health status.
Health Services Delivery: Reframing Policies for Global Nursing Migration in North America—A Canadian Perspective
Authors: Keatings Margaret
Published: October 2006

A number of initiatives are currently under way to address the Canadian Nursing Sector Study’s recommendations for integrated human resource planning, including some of the particular challenges posted by international nurse migration. This article identifies and discusses some of the initiatives currently being undertaken in Ontario and elsewhere.
Nation-to-Nation Challenges to Addressing the Effects of Emerging Global Nurse Migration on Health Care Delivery
Authors: Denton Sylvia
Published: October 2006

The United Kingdom is highly dependent on international nurse migration from developing countries. This paper presents an overview of the Royal College of Nursing's concerns with and proposals for addressing the issues raised by international nurse migration.
Directions for the Development of Nursing Knowledge
Authors: Sullivan-Marx Eileen M.
Published: October 2006

Nurses and health care increasingly are embracing and guided by achievements and challenges of evidence-based practice and reflective practice. Nursing science advances have positioned nurses to move forward in the development of science. New directions for nursing knowledge need to emerge in several ways including the development of interdisciplinary knowledge, emphasis on the nursing care process, creation of new work-force patterns, and development of economic theories of nursing practice.
Health Services Delivery: Reframing Policies for Global Nursing Migration in North America—A Caribbean Perspective
Authors: Yan Jean
Published: October 2006

Countries of the Caribbean face critical challenges in nurse migration and health services delivery. They are experiencing two types of migration—country-to-country migration within the Caribbean and migration from the Caribbean to developed countries, including the United States, Canada, and the United Kingdom. Aggressive international recruitment practices in the Caribbean resulted in a dramatic loss of nurses in the region and had an adverse impact on health-services delivery. A Managed Migration Program is being developed with two guiding principles—observing the rights of individual nurses to choose where they want to work and live while balancing individual rights with a country’s obligation to provide quality health services to its citizens. It is a multi-country, multi-agency, multi-interventional strategy to increase intake, production, and retention of nurses. Various efforts designed to balance nursing supply and demand are underway, with the goal of providing universal, effective, and quality health care in the Caribbean.
Bringing Nursing Leadership to Shaping State Policy: An Interview With Virginia Trotter Betts
Authors: Keepnews David M.
Published: October 2006

In this interview, Virginia Trotter Betts, JD, MSN, RN, FAAN, a former American Nurses Association (ANA) president who has served in leading national health policy roles, discusses her current role and experiences as Commissioner of the Tennessee Department of Mental Health and Developmental Disabilities.
In vivo control of acute lymphoblastic leukemia by immunostimulatory CpG oligonucleotides
Authors: Fujii Hisaki , Trudeau Jacqueline D. , Teachey David T. , Fish Jonathan D. , Grupp Stephan A. , Schultz Kirk R. , Reid Gregor S. D.
Published: October 2006

Despite considerable success in treating newly diagnosed childhood acute lymphoblastic leukemia (ALL), relapsed disease remains a significant clinical challenge. Using a NOD/SCID mouse xenograft model, we report that immunostimulatory DNA oligonucleotides containing CpG motifs (CpG ODNs) stimulate significant immune activity against primary human ALL cells in vivo. The administration of CpG ODNs induced a significant reduction in systemic leukemia burden, mediated continued disease control, and significantly improved survival of mice with established human ALL. The death of leukemia cells in vivo was independent of the ability of ALL cells to respond directly to CpG ODNs and correlated with the production of IL-12p70, IFN-α, and IFN-γ by the host. In addition, depletion of natural killer cells by anti–asialo-GM1 treatment significantly reduced the in vivo antileukemic activity of CpG ODN. This antileukemia effect was not limited to the xenograft model because natural killer cell–dependent killing of ALL by human peripheral blood mononuclear cells (PBMCs) was also increased by CpG ODN stimulation. These results suggest that CpG ODNs have potential as therapeutic agents for the treatment of ALL.
Tumor necrosis factor α (TNF-α) receptor-II is required for TNF-α–induced leukocyte-endothelial interaction in vivo
Authors: Chandrasekharan Unni M. , Siemionow Maria , Unsal Murat , Yang Lin , Poptic Earl , Bohn Justin , Ozer Kagan , Zhou Zhongmin , Howe Philip H. , Penn Marc , DiCorleto Paul E.
Published: October 2006

Tumor necrosis factor-α (TNF-α) binds to 2 distinct cell-surface receptors: TNF-α receptor-I (TNFR-I: p55) and TNF-α receptor-II (TNFR-II: p75). TNF-α induces leukocyte adhesion molecules on endothelial cells (ECs), which mediate 3 defined steps of the inflammatory response; namely, leukocyte rolling, firm adhesion, and transmigration. In this study, we have investigated the role of p75 in TNF-α–induced leukocyte adhesion molecules using cultured ECs derived from wild-type (WT), p75-null (p75−/−), or p55-null (p55−/−) mice. We observed that p75 was essential for TNF-α–induced E-selectin, vascular cell adhesion molecule 1 (VCAM-1), and intercellular adhesion molecule 1 (ICAM-1) expression. We also investigated the putative role of p75 in inflammation in vivo using an intravital microscopic approach with a mouse cremaster muscle model. TNF-α–stimulated leukocyte rolling, firm adhesion to ECs, and transmigration were dramatically reduced in p75−/− mice. Transplanted WT cremaster in p75−/− mice showed a robust leukocyte rolling and firm adhesion upon TNF-α activation, suggesting that the impairment in EC-leukocyte interaction in p75−/− mice is due to EC dysfunction. These results demonstrate, for the first time, that endothelial p75 is essential for TNF-α–induced leukocyte–endothelial-cell interaction. Our findings may contribute to the identification of novel p75-targeted therapeutic approaches for inflammatory diseases.
Autologous hematopoietic stem cell transplantation in refractory celiac disease with aberrant T cells
Authors: Al-toma Abdulbaqi , Visser Otto J. , van Roessel Hyacintha M. , von Blomberg B. Mary E. , Verbeek Wieke H. M. , Scholten Petra E. T. , Ossenkoppele Gert J. , Huijgens Peter C. , Mulder Chris J. J.
Published: October 2006

Autologous hematopoietic stem cell transplantation (ASCT) is an increasingly accepted treatment for refractory autoimmune diseases. Refractory celiac disease with aberrant T cells (RCD type II) is unresponsive to available therapies and carries a high risk of transition into enteropathy associated T-cell lymphoma (EATL). This study reports on the feasibility, safety, and efficacy of ASCT in patients with RCD type II. Thirteen patients with RCD type II were evaluated. Seven patients (4 men, 3 women, mean age 61.5 years [range, 51-69 years]) underwent transplantation. After conditioning with fludarabine and melphalan, ASCT was performed. Patients were monitored for response, adverse effects, and hematopoietic reconstitution. All 7 patients completed the mobilization and leukapheresis procedures successfully and subsequently underwent conditioning and transplantation. Engraftment occurred in all patients. No major nonhematologic toxicity or transplantation-related mortality was observed. There was a significant reduction in the aberrant T cells in duodenal biopsies associated with improvement in clinical well-being and normalization of hematologic and biochemical markers (mean follow-up, 15.5 months; range, 7-30 months). One patient died 8 months after transplantation from progressive neuroceliac disease. These preliminary results showed that high-dose chemotherapy followed by ASCT seems feasible and safe and might result in long-term improvement of patients with RCD type II whose condition did not respond promptly to available drugs.
Characterisation of a transgenic mouse expressing R122H human cationic trypsinogen
Authors: Selig Lena , Sack Ulrich , Gaiser Sebastian , Klöppel Günter , Savkovic Vuk , Mössner Joachim , Keim Volker , Bödeker Hans
Published: October 2006

Background

The R122H mutation of the cationic trypsinogen was found in patients with hereditary pancreatitis. A transgenic animal carrying this mutation could be useful as a genetic model system of pancreatitis.

Methods

Mice transgenic for the human R122H cationic trypsinogen were generated using the -205 fragment of the rat elastase promoter. The presence of the transgene was assayed in the DNA, in pancreatic mRNA and in zymogen granule lysates. Serum levels of amylase, lipase and cytokines (MCP-1, IL-6) were monitored and the histological appearance of the tissue was investigated. Pancreatitis was induced by 7 hourly injections of 50 μg/kg cerulein. The procedure was repeated twice weekly for 10 consecutive weeks. The animals were sacrificed 24 (n = 8) and 48 hours (n = 8) after the first injection and at the end of the whole treatment (n = 7).

Results

The transgene was detected at the genomic level and in pancreatic mRNA. The corresponding protein was found in low amounts in zymogen granule lysates. R122H mice showed elevated pancreatic lipase, but there was no spontaneous development of pancreatitis within 18 months. After induction of pancreatitis, levels of lipase (after 24 hours) and amylase (after 48 hours) were higher in R122H mice compared to controls. Repeated treatment with cerulein resulted in a slightly more severe pancreatitis in R122H animals. Amylase, lipase, and the cytokine levels were similar to controls.

Conclusion

The R122H transgenic mouse failed to develop a spontaneous pancreatitis but a repeatedly provoked cerulein-induced pancreatitis led to a slightly more severe pancreatitis. The rather small difference in comparison to controls could be due to the low expression of the transgene in the mouse pancreas.
Large-scale computations on histology images reveal grade-differentiating parameters for breast cancer
Authors: Petushi Sokol , Garcia Fernando U , Haber Marian M , Katsinis Constantine , Tozeren Aydin
Published: October 2006

Background

Tumor classification is inexact and largely dependent on the qualitative pathological examination of the images of the tumor tissue slides. In this study, our aim was to develop an automated computational method to classify Hematoxylin and Eosin (H&E) stained tissue sections based on cancer tissue texture features.

Methods

Image processing of histology slide images was used to detect and identify adipose tissue, extracellular matrix, morphologically distinct cell nuclei types, and the tubular architecture. The texture parameters derived from image analysis were then applied to classify images in a supervised classification scheme using histologic grade of a testing set as guidance.

Results

The histologic grade assigned by pathologists to invasive breast carcinoma images strongly correlated with both the presence and extent of cell nuclei with dispersed chromatin and the architecture, specifically the extent of presence of tubular cross sections. The two parameters that differentiated tumor grade found in this study were (1) the number density of cell nuclei with dispersed chromatin and (2) the number density of tubular cross sections identified through image processing as white blobs that were surrounded by a continuous string of cell nuclei. Classification based on subdivisions of a whole slide image containing a high concentration of cancer cell nuclei consistently agreed with the grade classification of the entire slide.

Conclusion

The automated image analysis and classification presented in this study demonstrate the feasibility of developing clinically relevant classification of histology images based on micro- texture. This method provides pathologists an invaluable quantitative tool for evaluation of the components of the Nottingham system for breast tumor grading and avoid intra-observer variability thus increasing the consistency of the decision-making process.
Screening for plant transporter function by expressing a normalized Arabidopsis full-length cDNA library in Xenopus oocytes
Authors: Nour-Eldin Hussam H , Nørholm Morten HH , Halkier Barbara A
Published: October 2006

Background

We have developed a functional genomics approach based on expression cloning in Xenopus oocytes to identify plant transporter function. We utilized the full-length cDNA databases to generate a normalized library consisting of 239 full-length Arabidopsis thaliana transporter cDNAs. The genes were arranged into a 96-well format and optimized for expression in Xenopus oocytes by cloning each coding sequence into a Xenopus expression vector.

Results

Injection of 96 in vitro transcribed cRNAs from the library in pools of columns and rows into oocytes and subsequent screening for glucose uptake activity identified three glucose transporters. One of these, AtSTP13, had not previously been experimentally characterized.

Conclusion

Expression of the library in Xenopus oocytes, combined with uptake assays, has great potential in assignment of plant transporter function and for identifying membrane transporters for the many plant metabolites where a transporter has not yet been identified.
Colony-Stimulating Factor-1 Increases Osteoclast Intracellular pH and Promotes Survival via the Electroneutral Na/HCO3 Cotransporter NBCn1
Authors: Bouyer Patrice , Sakai Hiroaki , Itokawa Takashi , Kawano Tsutomu , Fulton Christiaan M. , Boron Walter F. , Insogna Karl L.
Published: October 2006

Colony-stimulating factor-1 (CSF-1) promotes the survival of osteoclasts, short-lived cells that resorb bone. Although a rise in intracellular pH (pHi) has been linked to inhibition of apoptosis, the effect of CSF-1 on pHi in osteoclasts has not been reported. The present study shows that, in the absence of CO2/HCO3−, CSF-1 causes little change in osteoclast pHi. In contrast, exposing these cells to CSF-1 in the presence of CO2/HCO3− causes a rapid and sustained cellular alkalinization. The CSF-1-induced rise in pHi is not blocked by 4,4′-diisothiocyanatostilbene-2,2′-disulfonic acid, an inhibitor of HCO3− transporters but is abolished by removing extracellular sodium. This inhibition profile is similar to that of the electroneutral Na/HCO3 cotransporter NBCn1. By RT-PCR, NBCn1 transcripts are present in both osteoclasts and osteoclast-like cells (OCLs), and by immunoblotting, the protein is present in OCLs. Moreover, CSF-1 promotes osteoclast survival in the presence of CO2/HCO3− buffer but not in its absence. Preventing the activation of NBCn1 markedly attenuates the ability of CSF-1 to 1) block activation of caspase-8 and 2) prolong osteoclast survival. Inhibiting caspase-3 or caspase-8 in OCLs prolongs osteoclast survival to the same extent as does CSF-1. This study provides the first evidence that osteoclasts express a CSF-1-regulated Na/HCO3 cotransporter, which may play a role in cell survival.
Phosphate Stimulates Matrix Gla Protein Expression in Chondrocytes through the Extracellular Signal Regulated Kinase Signaling Pathway
Authors: Julien M. , Magne D. , Masson M. , Rolli-Derkinderen M. , Chassande O. , Cario-Toumaniantz C. , Cherel Y. , Weiss P. , Guicheux J.
Published: October 2006

Whereas increasing evidence suggests that inorganic phosphate (Pi) may act as a signaling molecule in mineralization-competent cells, its mechanisms of action remain largely unknown. The aims of the present work were to determine whether Pi regulates expression of matrix Gla protein (MGP), a mineralization inhibitor, in growth plate chondrocytes and to identify the involved signaling pathways. Chondrogenic ATDC5 cells and primary growth plate chondrocytes were used. Messenger RNA and protein analyses were performed by quantitative PCR and Western blotting, respectively. The activation and role of MAPKs were, respectively, determined by Western blotting and the use of specific inhibitors. Immunohistological detection of ERK1/2 was performed in rib organ cultures from newborn mice. The results indicate that Pi markedly stimulates expression of MGP in ATDC5 cells and primary growth plate chondrocytes. Investigation of the involved intracellular signaling pathways reveals that Pi activates ERK1/2 in a cell-specific manner, because the stimulation was observed in ATDC5 and primary chondrocytes, MC3T3-E1 osteoblasts, and ST2 stromal cells, but not in L929 fibroblasts or C2C12 myogenic cells. Accordingly, immunohistological detection of ERK1/2 phosphorylation in rib growth plates revealed a marked signal in chondrocytes. Finally, a specific ERK1/2 inhibitor, UO126, blocks Pi-stimulated MGP expression in ATDC5 cells, indicating that ERK1/2 mediates, mainly, the effects of Pi. These data demonstrate, for the first time, that Pi regulates MGP expression in growth plate chondrocytes, thereby suggesting a key role for Pi and ERK1/2 in the regulation of bone formation.
Histone Deacetylase Inhibitors Stimulate Cell Migration in Human Endometrial Adenocarcinoma Cells through Up-Regulation of Glycodelin
Authors: Uchida Hiroshi , Maruyama Tetsuo , Ono Masanori , Ohta Kuniaki , Kajitani Takashi , Masuda Hirotaka , Nagashima Takashi , Arase Toru , Asada Hironori , Yoshimura Yasunori
Published: October 2006

Histone deacetylase inhibitors (HDACIs) have recently emerged as promising anticancer drugs to induce cell cycle arrest, cytodifferentiation, and apoptosis. It is suggested, however, that HDACIs promote cell migration and invasion depending on the cell type. We have reported previously that treatment with HDACIs, including trichostatin A and suberoylanilide hydroxamic acid (SAHA) or progesterone in combination with estrogen, can induce cytodifferentiation of endometrial adenocarcinoma Ishikawa cells through up-regulation of glycodelin, a progesterone-induced endometrial glycoprotein. Given the reported role of glycodelin in cell motility and the migration-modulating potential of HDACIs, we investigated using wound healing assay and transwell migration assay whether ovarian steroid hormones, trichostatin A, or SAHA affects cell migration in endometrial cancer cell lines, Ishikawa and RL95-2. Treatment with ovarian steroid hormones, trichostatin A, and SAHA enhanced cell migration together with up-regulation of glycodelin. SAHA-augmented cell migration was almost completely blocked by gene silencing of glycodelin. Furthermore, overexpression of gycodelin alone resulted in increased cell motility in Ishikawa cells. Our results collectively indicate that glycodelin positively regulates cell motility acting as a mediator of HDACI-enhanced endometrial cell migration, suggesting the involvement of glycodelin in the dynamic endometrial gland morphogenesis during menstrual cycle. Our results raise a possibility that the use of HDACIs in the therapy for glycodelin-inducible endometrial and presumably other gynecological cancers may enhance invasion in cases in which the HDACIs fail to exert differentiation-inducing and/or antiproliferative effects.
Cyclooxygenases in Rat Leydig Cells: Effects of Luteinizing Hormone and Aging
Authors: Chen Haolin , Luo Lindi , Liu June , Zirkin Barry R.
Published: October 2006

Previous studies suggested that increased Leydig cell cyclooxygenase (COX)2 expression may be involved in the reduced testosterone production that characterizes aged Leydig cells. Our objective herein was to further elucidate the relationships among LH stimulation, Leydig cell COX2 and COX1 expression, aging, and testosterone production. Incubation of Leydig cells from young or aged rats with LH or dibutyryl cAMP resulted in increases in both intracellular COX2 protein expression and testosterone production. COX1 expression did not respond to LH or dibutyryl cAMP. Incubation of adult cells with a protein kinase A inhibitor suppressed the stimulatory effects of LH on COX2 and testosterone production. Short-term incubation of Leydig cells with TGF-α or IL-1β also increased COX2 protein levels; IGF-I had no effect. In vivo, LH also was found to stimulate both COX2 and testosterone, but not COX1. As reported previously, COX2 expression was greater in old than in young cells, and old Leydig cells responded to inhibition of COX2 in vitro with increased testosterone production. However, the effects of the COX2 inhibitors were not restricted to old cells; young Leydig cells also responded to COX2 inhibition with increased testosterone production. This and the observation that the incubation of young or old cells with LH resulted in increased COX2 and testosterone production in both cases suggests that the relationship between COX2 and testosterone production is not unique to aged Leydig cells. Moreover, the close correlation between increases in COX2 and testosterone in LH-stimulated young and aged Leydig cells is difficult to reconcile with the contention that the increased expression of COX2 in aged cells is responsible for age-related suppression of Leydig cell testosterone production.
Market Entry and Consumer Behavior: An Investigation of a Wal-Mart Supercenter
Authors: Singh Vishal P. , Hansen Karsten T. , Blattberg Robert C.
Published: October 2006

This paper provides an empirical study of entry by a Wal-Mart supercenter into a local market. Using a unique frequent-shopper database that records transactions for over 10,000 customers, we study the impact of Wal-Mart’s entry on consumer purchase behavior. We develop a joint model of interpurchase time and basket size to study the impact of competitor entry on two key household decisions: store visits and in-store expenditures. The model also allows for consumer heterogeneity due to observed and unobserved factors. Results show that the incumbent supermarket lost 17% volume—amounting to a quarter million dollars in monthly revenue—following Wal-Mart’s entry. Decomposing the lost sales into components attributed to store visits and in-store expenditures, we find that the majority of these losses were due to fewer store visits with a much smaller impact attributed to basket size. We also find that Wal-Mart lures some of the incumbent’s best customers, and that retention of a small number of households can significantly reduce losses at the focal store. Finally, certain observed household characteristics such as distance to store, shopping behavior, and product purchase behavior are found to be useful in profiling the defectors to Wal-Mart. Implications and strategies for supermarket managers to compete with Wal-Mart are discussed.
Returns on Business-to-Business Relationship Marketing Investments: Strategies for Leveraging Profits
Authors: Palmatier Robert W. , Gopalakrishna Srinath , Houston Mark B.
Published: October 2006

Firms invest heavily in different types of business-to-business relationship marketing activities in the belief that such programs bolster their bottom line. In this study, we develop and test a conceptual model that links customer-specific relationship marketing investments to short-term, customer-specific financial outcomes. Data from a matched set of 313 business customers covered by 143 salespeople of 34 selling firms indicate that investments in social relationship marketing pay off handsomely, financial relationship marketing investments do not, and structural relationship marketing investments are economically viable for customers serviced frequently. We conceptualize relationship marketing in a context involving nested participants (customers, salespeople, selling firms) and employ a hierarchical linear modeling approach to account for observations that are not independent. Across the three hierarchical levels, the impact of the financial, social, and structural components of relationship marketing investments and the potential moderating factors offer valuable insights into contextual factors and managerial strategies for leveraging relationship marketing investments. In an attempt to suggest normative guidelines to managers, we extend our analysis to a simple resource allocation model that describes the optimal mix of relationship marketing resources based on firm strategies.
Editorial: Who Is Afraid to Give Freedom of Speech to Marketing Folks?
Authors: Shugan Steven M.
Published: October 2006

Despite the invaluable contribution of marketing folks (e.g., making markets work), they fail to enjoy the same freedom of speech as others. This fact is particularly egregious because unlike other groups that can use threats, force, or coercion, marketing folks rely only on speech. Although the U.S. Constitution never mentions commercial speech, the courts invented the concept to censor marketing folks. The cloudy rational was that consumers need special protection from marketing folks (e.g., advertising). Naturally, censorship leads to abuse. Powerful incumbents use censorship covertly against new entrants. Politicians use censorship surreptitiously to promote their own political goals. If consumers need protection, it is certainly from the misleading statements of those with freedom of speech—politicians, attorneys, the news media, and the censors.
An evaluation of the carbon dioxide laser in the treatment of traumatic laryngeal stenosis
Authors: Shugar Joel M. A. , Som Peter M. , Biller Hugh F.
Published: October 2006

The most common cause of laryngeal stenosis is trauma. The treatment of this condition is difficult as attested to by the numerous procedures described in the literature. Recently a new modality, the CO2 laser, has been added to the list. The advantage of this procedure is that it can be performed endoscopically.

The purpose of this paper is to present 16 cases of traumatic laryngeal stenosis treated by the laser. The chance of achieving a successful result was greatest in patients with supraglottic stenosis due to redundant soft tissue or localized scaring.
Cervical cysts: Cancer until proven otherwise?
Authors: Cinberg James Z. , Silver Carl E. , Molnar John J. , Vogl Steven E.
Published: October 2006

A cystic neck mass can be either malignant or benign; 22% of patients (4/18) admitted with the tentative diagnosis of branchial cyst in a recent 2‐year period (1977‐1979) had metastatic carcinoma: epidermoid, thyroid or salivary gland. Preoperative fine needle aspiration was diagnostic in 1 instance and unhelpful in 2. Frozen section analysis of the gross specimen invariably provided the correct diagnosis. All patients with malignancies had subclinical primary disease and in 1 instance random biopsies identified its origin.

The prudent surgeon will avoid untoward results if he approaches a neck cyst in an adult as if it were malignant. Guidelines he can follow to prevent the inadvertent removal of a metastasis under the misapprehension that it is a benign neck cyst include: 1. Prior to operation, perform a thorough head and neck examination to identify a primary carcinoma; 2. Do a fine needle aspiration of the mass for cytology. A negative report must be considered inconclusive; 3. Make a gross examination in the operating room of the opened cyst and frozen section processing of suspicious areas; 4. Follow with a panendoscopy and random biopsies of appropriate areas and omplete the neck dissection on the involved side, after a metastatic deposit has been recognized. The preoperative procurement of contingency consent for these procedures is understood.
Adenocarcinoma and adenoma of the middle ear
Authors: Pallanch John F. , Weiland Louis H. , Mcdonald Thomas J. , Facer George W. , Harner Stephen G.
Published: October 2006

Primary middle ear glandular tumors of the adenocarcinoma and adenoma types are rare. The terminology used in describing them is quite varied. Some investigators presume that a distinct recognizable group of these tumors are benign, but because of the rarity of the lesions, such conclusions have been difficult to verify. We review the literature of these lesions and report 11 additional cases. The course was documented in 25 cases in the literature; 20 of these were reported to be benign over periods of follow‐up from 1 month to 10 years, and 5 were fatal. Among our patients, 5 had a benign course, 3 died of causes related to the tumor, and 3 had persistence of their lesion and substantial consequent morbidity. We emphasize the slow growth and elusive nature of these lesions. Histologic evidence of mitoses, roentgenologic evidence of bony destruction, and cranial nerve involvement were factors consistent with a poor prognosis. The origin of these tumors may vary. A similarity to paragangliomas is noted. The ultimate course of these tumors cannot always be predicted from the histologic appearance. Early surgical removal appears to be the most successful therapy.

Three of the 4 types of glandular tumors of the external ear canal described by Wetli, et al, can be found in the middle ear: adenoma, adenocarcinoma, and adenoid cystic carcinoma. In addition, several other types of glandular lesions can occur in the middle ear — the “choristomas,” mucoepidermoid carcinomas, and what we believe to be a variant of paragangliomas. The adenoid cystic tumors are well described in the literature2 and will not be discussed here. We reviewed cases of the adenoma and adenocarcinoma types, some of which bore a resemblance to the paragangliomas.
Transnasal, transeptal sphenoidal approach to hypophysectomy
Authors: Tucker Harvey M. , Hahn Joseph F.
Published: October 2006

Since 1960 the most useful and widely employed technique for transphenoidal hypophysectomy has generally been via the sublabial, transeptal approach. This procedure has offered excellent exposure, limited blood loss and a direct, midline approach through the sphenoid to the hypophysis, thus preserving certain midline structures as a guide to the appropriate point of entry into the Bella turcica. This approach has certain drawbacks, however, not the least of which is the extensive sublabial incision that must be made and the need to remove or otherwise interfere with the nasal spine. This maneuver can result in changes in the vertical dimension of the septal‐collumellar area and, more important, often results in permanent numbness of the upper teeth. In patients who wear dentures, it will sometimes produce a bothersome scar which will require refitting or change in wearing patterns for these dentures. It also requires surgical closure.

For the past two years at the Cleveland Clinic Foundation a modified transeptal, transphenoidal approach to hypophysectomy has been undertaken conjointly between the Department of Otolaryngology and Communicative Disorders and the Department of Neurosurgery. This approach to hypophysectomy may offer a good alternative to the sublabial approach, and in competent hands avoids some of the complications of the latter procedure.
Paradoxical vocal cord motion: An important cause of stridor
Authors: Kellman Robert M. , Leopold Donald A.
Published: October 2006

Paradoxical vocal cord motion (PVCM) is an important cause of laryngeal stridor and dysphonia; however, only two previous cases have been reported. We report three additional cases, one of which was tracheotomized on two occasions before the diagnosis was made. These patients, typically young females who have had a recent upper respiratory infection, present with stridor. They can phonate weakly, but they cannot cough. Indirect laryngoscopy reveals smooth, symmetric vocal cord adduction on inspiration and abduction on expiration. Laboratory values are normal. PVCM appears to be self‐limited (up to 72 hours), and patients respond to supportive care and sedation. Tracheotomy appears to be unnecessary.

The etiology is obscure and may be functional; however, a case is discussed in which PVCM was seen in association with chronic aspiration in a patient with organic brain syndrome. An awareness of this entity and a high index of suspicion can prevent unnecessary tracheotomy.
Peritonsillar abscess: Tonsil antibiotic levels in patients treated by acute abscess surgery
Authors: Maisel Robert H.
Published: October 2006

Forty‐five patients who had tonsillectomy in the acute phase of peritonsillar abscess were studied. All patients received intravenous penicillin or cephalosporin before surgery. Samples of tonsil from each side were evaluated for penicillin and cephalosporin as was a blood sample obtained during surgery. The tonsil tissue antibiotic levels were compared between the infected and non‐abscess side. We expected to find less antibiotic on the inflamed side since less bleeding from the abscessed tonsil bed usually suggests less blood flow through this tonsil, and we also expected a low, satisfactory tissue level in patients under usual regimens of intravenous antibiotics.

Our results indicate that 60% of the patients had evidence of streptococcal infections by culture or serum assay. All patients completed the treatment without complications. Eighty‐five percent of abscesses were in the superior pole and 15% were located posteriorly and would be adequately drained only by tonsillectomy. There was no clear seasonal peak to the infection and no evidence of specific virulence of the streptococci found. Tissue antibiotic assay showed only 32% of the patients on penicillin had a measurable tissue level and 66% of the cephalosporin treated patients had detectable antibiotic levels in the tissue. The abscessed tonsil was equally as likely to have increased levels of penicillin as its uninflamed mate while in all cases, where detectable, the abscessed tonsil had increased concentrations of cephalosporin relative to the opposite side. We conclude that penicillin does not penetrate tonsil tissue very well and does not favor either the infected or uninfected side while the cephalosporins may have a specific reduced tissue barrier to penetration in the presence of inflammation. Therefore, we recommend medical treatment with 1 gm of penicillin intravenously every 4 hours or 1 gm of cephalosporin every 6 to 8 hours intravenously with an additional dose of the intravenous antibiotic at the time of tonsillectomy.
Carcinoma in papillary cystadenoma lymphomatosum (Warthin's tumor)
Authors: Mcclatchey Kenneth D. , Appelblantt Nancy H. , Langin John L.
Published: October 2006

Compared to the number of reported cases of a papillary cystadenoma lymphomatosum, malignant transformation is a rare event. This paper presents the third documented case of squamous cell carcinoma arising in the papillary cystadenoma lymphomatosum in a lymph node of the parotid region. Review of the American literature reveals 5 other cases of malignant transformation of papillary cystadenoma lymphomatosum including two cases of adenocarcinoma and one case of mucoepidermoid carcinoma with an apparent low potential for metastatic spread.
Airway obstruction in lefort fractures
Authors: Thompson James N. , Gibson Brian , Kohut Robert I.
Published: October 2006

Airway obstruction associated with fractures of the midfacial skeleton can be life‐threatening if not recognized promptly and treated appropriately. One hundred seventeen patients with LeFort fractures were treated between 1978 and 1984. Of the 117 patients, 21 had a LeFort I fracture, 46 had a LeFort II fracture, 14 had a LeFort III fracture, and 36 had various combinations of the three types of LeFort fractures.

Thirty‐one patients (26.5%) presented with airway obstruction, decreased respiration, or both, requiring either tracheotomy or endotracheal intubation. Of the 31 patients undergoing emergent tracheotomy or endotrachealintubation, 26 (83.9%) had loss of consciousness relating to their injuries. Thirty‐nine (33.3%) additional patients had an elective tracheotomy either at the time of surgical repair of their fractures or for prolonged endotracheal intubation.

Age and sex of the patients played no role in the incidence of airway complications in patients with LeFort fractures. Patients with LeFort III fractures and those with associated injuries such as mandible fracture, laryngeal and pharyngeal injury, and chest or closed head injury are at greater risk for requiring emergent control of the airway.
Hunter's syndrome: A study in airway obstruction
Authors: Sasaki Clarence T. , Ruiz Richard , Kirchner John A. , Gaito Raymond , Seshi Beerelli
Published: October 2006

Hunter's disease is a genetically transmitted defect known to produce mucopolysaccharide infiltration of multiple organ systems. Upper airway obstruction is caused by an enlarged tongue, deformed pharynx, and short, thick neck. Its eventual lethal outcome by the second decade of life is known to result from an infiltrative cardiomyopathy leading to irreversible heart failure. Instead, our recent experience in the care of five patients with this disorder suggests the lethal event is related to progressive obstruction sequentially involving the upper, mid, and lower airway characterized by gradual deformation and collapse of the trachea. Autopsy and histopathologic whole organ sections demonstrate anteroposterior flattening of the trachea and bronchi with submucosal thickening producing structural alterations known only to this disease.
Determination of obstructive site in obstructive sleep apnea
Authors: Crumley Roger L. , Stein Mark , Golden Jeff , Gamsu Gordon , Dermon Sabri
Published: October 2006

Patients with obstructive sleep apnea syndrome (OSAS) may have airway obstruction at various levels, including the uvula‐soft palate complex, base of tongue, and/or possibly other sites. For patients with tongue base and/or laryngeal obstruction, uvulopalatopharyngoplasty (UPPP, ppp) will not alleviate the obstruction. Prior authors have proposed that the hyoid bone position as determined by cephalometric x‐rays can predict which patients have obstruction at a lower site than the soft palate.

In this study, patients with obstructive sleep apnea syndrome were evaluated with polysomnographic testing, fiberoptic endoscopy, and cine‐CT scans (Imatron Scanner with multiple level rapid sequence scans) in an attempt to determine precisely the site of airway obstruction. Measurements of airway size taken at the time of fiberoptic pharyngoscopy were compared with those determined by the cine‐CT studies.

Initial results revealed that fiberoptic pharyngoscopy in the sitting and supine positions was helpful in confirming pharyngeal airway sites with smaller diameters in awake patients. However, the cine‐CT exam performed in both sleeping and awake states provided more direct data regarding the airway during sleep. We feel that with more clinical experience the cine‐CT technique will prove to be the most helpful study for identification of the obstructive airway site in obstructive sleep apnea syndrome.
Nasopharyngeal Complications Following Uvulopalatopharyngoplasty
Authors: Katsantonis George P. , Friedman William H. , Krebs Festus J. , Walsh James K.
Published: October 2006

This report presents our experience with nasopharyngeal complications of UPPP in 85 patients undergoing the procedure from May, 1982 to January, 1985. Three patients developed nasopharyngeal stenosis and one patient developed permanent velopharyngeal insufficiency. Surgical management in two patients with nasopharyngeal stenosis resulted in adequate nasopharyngeal airway, while one patient still has a moderate stenosis following two surgical procedures. The patient with velopharyngeal insufficiency underwent Teflon® paste injection in the posterior pharyngeal wall. This resulted in complete alleviation of his nasal regurgitation.
Determinants of otic capsule formation
Authors: Van De Water Thomas R. , Mcphee Joseph R.
Published: October 2006

The otocyst is the epithelial anlage of the membranous labyrinth that interacts with surrounding head mesenchyme tissue during formation of the otic capsule. In vitro studies were performed to gain a better understanding of the role that epithelial‐mesenchymal tissue interactions play in development of the otic capsule. Parallel series of otocyst/mesenchyme (O/M) and isolated periotic mesenchyme (M) explants provided morphological and biochemical data. The results indicate that epithelial‐mesenchymal tissue interactions control development of both the otic capsule and the perilymphatic spaces. The otocyst induces cartilage differentiation in periotic mesenchyme between embryonic days 11 to 13 and organizes otic capsule morphology between embryonic days 13 to 14 in the mouse embryo. The otocyst exerts a localized repression of chondrogenesis in nearby mesenchyme during perilymphatic space formation on embryonic days 12 to 14.
Tolusa‐hunt syndrome: Resolution of a 12‐year course after tonsillectomy
Authors: Frable Mary Ann Smith , Myer Edwin C.
Published: October 2006

The authors review the symptoms, physical findings, possible causes, and treatment of Tolusa‐Hunt syndrome (THS). The authors present a patient with THS and tonsillitis. The symptoms, except for blindness, were alleviated after tonsillectomy. Anatomical relationships of the tonsils to the cavernous sinus are demonstrated and tonsillitis as a possible trigger mechanism of THS is suggested.
Respiratory activity of the cricothyroid muscle in conscious humans
Authors: Woodson Gayle E.
Published: October 2006

The cricothyroid muscle serves as an accessory muscle of respiration in anesthetized animals. The functional significance of this activity is unknown. To determine respiratory cricothyroid muscle activity in conscious humans, cricothyroid muscle electromyogram was measured per‐cutaneously, along with posterior cricoarytenoid muscle electromyogram and esophageal pressure in six volunteers. Low level cricothyroid muscle activity with quiet breathing was observed in four subjects. In all subjects, cricothyroid muscle activity was recruited by voluntary deep breathing, brief airway occlusion, and hypercapnia. Continuous positive airway pressure at 7.5‐cm H2O increased expiratory cricothyroid muscle activity in all subjects, and suppressed inspiratory activity in five. These results indicate that respiratory reflexes of the cricothyroid muscle are operative in conscious humans.