bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Inappetent Hospitalised Cat: Clinical Approach to Maximising Nutritional Support
Authors: Chan Daniel L 
Published: October 2009

Practical relevance Inappetence is one of the most common presenting complaints in clinically ill cats requiring hospitalisation. When prolonged, poor food intake can lead to malnutrition and may be associated with impaired metabolic function, immunosuppression, compromised wound healing, and increased morbidity and mortality. It is important to recognise that inappetence or anorexia is always secondary to another condition, and that treatment goals should be targeted at the primary condition. The current emphasis in the nutritional support of hospitalised inappetent cats is to provide more effective means of increasing nutritional intake -for example, by initiating enteral nutrition via feeding tubes - rather than rely solely on traditional approaches such as increasing palatability of foods or using appetite-stimulating drugs. Clinical challenges Cats that are ill enough to require hospitalisation are at increased risk of becoming malnourished because of the combined catabolic effects of their disease and poor nutritional intake. This article highlights some of the problems encountered in treating inappetent cats and discusses a clinical approach to providing better nutritional support. Patient group Inappetence and anorexia are associated with a myriad of clinical conditions in cats and can be seen in individuals of any age or breed. Equipment Provision of nutritional support to cats may involve the use of feeding tubes such as nasooesophageal or oesophagostomy tubes. In cases where enteral nutrition is not feasible (eg, cats with gastrointestinal failure), parenteral nutrition should be considered. Evidence base Various studies have documented the high prevalence of inappetence or anorexia in clinically ill cats. Additional studies have linked poor food intake in cats with serious sequelae such as immunosuppression and hepatic lipidosis. More recently, techniques for providing more effective nutritional support, such as oesophagostomy tubes, have been clinically evaluated and shown to be associated with minimal complications.
Direct drug application to the round window: A comparative study of ototoxicity in rats
Authors: Murillo‐Cuesta Silvia , García‐Alcántara Fernando , Vacas Elena , Sistiaga Jon Alexander , Camarero Guadalupe , Varela‐Nieto Isabel , Rivera Teresa 
Published: October 2009

ObjectiveTo assess the validity of inducing ototoxicity in rats by applying a sponge soaked in kanamycin and furosemide on the round window.Study DesignBasic, randomized, nonblind experimental study.SettingAnimal models of cochlear damage and reliable methods of local drug delivery are fundamental to study hearing loss and to design new therapies.Subjects and MethodsFour experimental groups of six Wistar rats with different methods of drug administration were used: (1) injection of subcutaneous kanamycin (400 mg/kg) and intravenous furosemide (100 mg/kg); (2) local application of a sponge soaked in saline close to the round window; (3) animals for which the sponge was soaked in a solution containing kanamycin (200 mg/mL) and furosemide (50 mg/mL); and (4) sham‐operated rats. The tympanic bulla was exposed using a ventral approach, and a bullostomy was performed to visualize the round window membrane. Cochlear function was assessed by measuring the auditory brainstem response, and hearing thresholds in response to click and tone burst stimuli were determined as peak and interpeak latencies. At the end of the study, cochlear histology was analyzed.ResultsSystemic administration of kanamycin and furosemide induced profound hearing loss and severe hair cell damage. Local delivery of these ototoxic drugs caused comparable damage but avoided the systemic side effects of the drug. Sham‐operated and saline control animals did not experience functional alterations.ConclusionSituating a sponge soaked in kanamycin and furosemide on the round window membrane through the ventral approach is a reliable method to provoke local ototoxicity in rats.
Additional diagnostic value of 18F‐FDG PET‐CT in detecting retropharyngeal nodal metastases
Authors: Chu Hyung Ro , Kim Jin Hwan , Yoon Dae Young , Hwang Hee Sung , Rho Young‐Soo 
Published: October 2009

ObjectiveThis study investigated whether preoperative 18fluorine‐fluorodeoxyglucose positron emission tomography‐computed tomography (PET‐CT) scanning improved the diagnosis of retropharyngeal lymph node (RPLN) metastasis in patients with head and neck squamous cell carcinoma (HNSCC) relative to conventional imaging alone.Study DesignCase series with chart review.SettingUniversity hospital cancer center.Subjects and MethodsSixty‐three patients with HNSCC underwent RPLN dissection in accordance with our indications and were subsequently divided into two groups: CT/magnetic resonance imaging (MRI) only (group A, n = 33) and CT/MRI with PET‐CT (group B, n = 30). The preoperative radiological findings of each group were compared with the RPLN histopathologic findings, which served as the standard of reference.ResultsRPLN metastasis was confirmed histopathologically in 17 of 63 patients (27.0%): eight from group A and nine from group B. With the additional use of PET‐CT in group B, the sensitivity (88.9%), specificity (85.7%), and accuracy (86.7%) were higher than the respective values in group A (62.5%, 60.0%, and 60.6%). The positive and negative predictive values for group B (72.7% and 94.7%, respectively) were also higher than those for group A (33.3% and 83.3%, respectively). False‐positive results were obtained in 10 patients from group A and three patients from B; false‐negative findings occurred in three patients from group A and one patient from group B. The predictive power of the radiological findings was statistically significant in group B (P = 0.0017), with an odds ratio of 47.987 (95% confidence interval, 4.3‐535.0).Conclusion18F‐FDG PET‐CT, when used in combination with CT/MRI, increases diagnostic efficacy in the detection of RPLN metastases and may therefore be useful in screening high‐risk patients.
Hearing outcomes of daily intratympanic dexamethasone alone as a primary treatment modality for ISSHL
Authors: Hong Seok Min , Park Chan Hum , Lee Jun Ho 
Published: October 2009

ObjectiveIntratympanic (IT) dexamethasone offers a good method for avoiding systemic side effects in patients with sudden idiopathic sensorineural hearing loss (ISSHL). However, in most studies, IT was used as a salvage treatment for patients whose hearing failed to improve with the initial systemic treatment, or as an addition to conventional oral steroid protocols. Therefore, we investigated the outcomes of IT steroid administration as a primary treatment modality for ISSHL.Study DesignRandomized controlled study.SettingTertiary referral center.Subjects and MethodsTwo treatment methods, IT dexamethasone or oral prednisolone, were randomly assigned to 63 participants. A group of 32 patients (IT group) with ISSHL received IT dexamethasone once a day for eight days. A separate group of 31 patients (oral group), received oral prednisolone, also for eight days. We compared the hearing outcomes in the two groups.ResultsWe have found that the outcomes for patients treated with IT dexamethasone as a primary treatment modality for the management of ISSHL presented no difference in pure‐tone averages or hearing recovery rate compared with patients treated with oral steroids. However, differences were noted for hearing thresholds according to frequency: the threshold improvement at low frequencies (250, 500, and 1000 Hz) was not statistically significant between groups; at high frequencies, particularly 4000 and 8000 Hz, the threshold improvement was statistically higher in the oral group than in the IT group.ConclusionIT dexamethasone might be a good primary treatment method for ISSHL; but, for the management of ISSHL, we should keep in mind the differences in hearing outcomes with regard to frequency.
2D‐DIGE proteomic characterization of head and neck squamous cell carcinoma
Authors: Merkley Mark A. , Weinberger Paul M. , Jackson Lana L. , Podolsky Robert H. , Lee Jeffrey R. , Dynan William S. 
Published: October 2009

ObjectiveIdentify proteins that are differentially expressed between head and neck squamous cell cancer (HNSCC) and patient‐matched normal adjacent tissue, and validate findings in a separate patient cohort.Study DesignCross‐sectional study of surgical specimens.SettingTertiary care academic medical center.Subjects and MethodsLaser capture microdissection and two‐dimensional difference gel electrophoresis were used previously to establish proteomic profiles for tumor and normal adjacent tissue from 14 patients. Here, significance analysis of microarray was used to rank candidate biomarkers. Spots meeting statistical and biological criteria of significance were analyzed by liquid chromatography and tandem mass spectrometry to obtain protein identifications. The expression pattern of the highest‐ranked candidate biomarker (cornulin) was validated in a larger, independent patient cohort (n = 68) by immunohistochemical staining of a tissue microarray.ResultsOf 732 spots, 117 (15.9%) met criteria for significance. Identities were obtained for 39 spots, representing 17 different proteins. Four proteins were novel in the context of HNSCC: glutathione synthetase, which was upregulated; and cornulin (squamous epithelial heat shock protein 53), guanylate binding protein 6, and heat shock 70 kDa protein 5 (glucose‐regulated protein, 78 kDa), which were downregulated. Cornulin functions in the stress response in normal squamous epithelium, and reduced expression has been proposed as a marker of susceptibility to laryngopharyngeal reflux and other stressors. Loss of cornulin expression was confirmed in an independent HNSCC patient cohort (P < 0.001).ConclusionsDownregulation of cornulin is a prominent feature of the molecular signature of HNSCC identified by comparative proteomics. Cornulin may represent a link between HNSCC and other pathologies arising in stratified squamous epithelium.
Volume and distances of the maxillary sinus in craniofacial deformities with midfacial hypoplasia
Authors: Song Seung Yong , Hong Jong Won , Roh Tai Suk , Kim Yong Oock , Kim Deok Won , Park Beyoung Yun 
Published: October 2009

ObjectiveCraniofacial deformities (CFDs) frequently accompany midfacial hypoplasia. The authors evaluated characteristics of maxillary sinuses that had CFDs with variable degrees of midfacial hypoplasia.Study DesignCross‐sectional survey with chart review.SettingDepartment of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.Subjects and MethodsWe investigated 40 patients with CFDs having midfacial hypoplasia. Study group 1 (SG 1) consisted of eight patients with Crouzon syndrome (16 maxillary sinuses). Study group 2 (SG 2) consisted of 10 patients with midfacial hypoplasia after palatoplasty (20 maxillary sinuses). Study group 3 (SG 3) consisted of 22 patients with Pruzansky grade I hemifacial microsomia (22 maxillary sinuses on the affected sides). Data on volume and three‐dimensional distances (height, width, and depth) from computed tomography were collected and compared with each corresponding control group. Correlation coefficient between volume and the three distances was also calculated.ResultsThe volume, height, width, and depth of the maxillary sinus were significantly decreased in SG 1 (P < 0.01). In SG 2, only the depth was significantly decreased (P < 0.05). In SG 3, there were no significant differences in any parameters. A multiple‐regression analysis between the volume and the three distances showed a statistically significant relationship for width in SG 1, width and height in SG 2, and all distances in SG 3.ConclusionThere were differences in the structure of the maxillary sinuses among patients with different CFDs.
In vitro testing of tympanostomy tube occlusion
Authors: Sherman Ethan G. , Antonelli Patrick J. , Tran‐Son‐Tay Roger 
Published: October 2009

ObjectiveTympanostomy tubes (TTs) are commonly rendered nonfunctional by mucus plug formation. The purpose of this study was to determine whether an in vitro model could be developed to assess TT plug formation with results consistent with human trials.Study DesignAn ear chamber was designed to mimic middle ear air and mucus flow conditions in post‐TT otorrhea. TT occlusion was tested and correlated to published in vivo results.MethodsTTs that had previously been studied in vivo (Goode “T” and Reuter Bobbin collar buttons) were placed in the model chamber. Pooled, homogenized human middle ear mucus and an analog, egg white, were delivered at 80 μL per hour through the TTs. An air bolus was delivered every two minutes to simulate swallowing. Chamber pressure was monitored over 2.5 hours. Occlusion was determined by a pressure peak and visual confirmation.ResultsObstruction was found in 60 percent of the Reuter Bobbin and 40 percent of the Goode TTs using the mucus analog. These results are similar to those reported from previous in vivo studies. No plugging was reported for either TT using homogenized human ear mucus.ConclusionsThe in vitro TT chamber simulates the in vivo environment and yields results consistent with in vivo observations. This model system may allow for rapid prototyping and evaluation of new TTs that may be less vulnerable to occlusion.
Pepsin as a causal agent of inflammation during nonacidic reflux
Authors: Samuels Tina L. , Johnston Nikki 
Published: October 2009

ObjectiveTo investigate the contribution of pepsin to inflammation attributed to nonacidic gastric reflux via analysis of inflammatory cytokine and cytokine receptor gene expression in pepsin‐treated human hypopharyngeal epithelial cells in vitro.Study DesignTranslational research.SettingThis study was performed in an academic research laboratory.Subjects and MethodsHuman hypopharyngeal epithelial cells were incubated with or without pepsin (0.1 mg/mL) at pH 7.4, 37°C, overnight. Expression of 84 inflammatory cytokines and cytokine receptors was analyzed via RT2 qPCR array.ResultsExpression of a number of inflammatory cytokines and receptors was altered in human hypopharyngeal epithelial cells following overnight treatment with pepsin at neutral pH. Greater than 1.5‐fold change in gene expression was detected for CCL20, CCL26, IL8, IL1F10, IL1A, IL5, BCL6, CCR6, and CXCL14 (P < 0.05).ConclusionExposure of hypopharyngeal cells to pepsin in a nonacidic environment induces the expression of several pro‐inflammatory cytokines and receptors, including those known to be involved in inflammation of esophageal epithelium in response to reflux and which contribute to the pathophysiology of reflux esophagitis. These data indicate that refluxed pepsin may contribute to laryngeal inflammation associated with nonacidic gastric reflux, including that experienced by patients despite maximal acid suppression therapy.
Effects of Exercise Training on Calf Tissue Oxygenation in Men With Intermittent Claudication
Authors: Figoni Stephen F. , Kunkel Charles F. , Scremin A.M. Erika , Asher Arash , Banks Norman L. , Rivera Anthony , Tin John K. , Cohen Babak 
Published: October 2009

ObjectiveTo determine the effects of exercise training on calf tissue oxygenation in men with peripheral arterial disease and intermittent calf claudication.DesignThis pilot study was prospective and longitudinal and used a one‐group, pretest‐posttest design.SettingTertiary care medical center for veterans.ParticipantsFifteen male veterans (mean age 69 years) with Fontaine stage IIa peripheral arterial disease and classic intermittent claudication.Main Outcome MeasurementsBefore and after intervention, participants performed graded treadmill exercise tests while medial calf tissue oxygenation (StO2, % oxyhemoglobin saturation) was monitored continuously with near‐infrared spectroscopy.InterventionThe intervention consisted of a 3‐month exercise training program involving 3 sessions per week at the clinic (treadmill walking, calf ergometry) and 2 sessions per week at home (free walking, standing heel raises).ResultsAfter completion of the intervention, participants significantly increased their maximal treadmill exercise time from 7.19 to 11.27 minutes. Mean exercise StO2 decreased from 29% to 19% saturation, StO2 × time area increased from 421% · min to 730% · min StO2 nadir, and StO2 recovery time did not change significantly.ConclusionsAfter the exercise intervention, the improved treadmill walking performance was accompanied by greater calf tissue deoxygenation during exercise. Given the continued presence of ischemia, this finding may represent increased capillarization and diffusion‐based enhancement of arteriovenous O2 extraction.
Sonographically Guided Posterior Subtalar Joint Injections: Anatomic Study and Validation of 3 Approaches
Authors: Henning Troy , Finnoff Jonathan T. , Smith Jay 
Published: October 2009

ObjectiveTo describe and validate 3 different approaches to perform sonographically guided posterior subtalar joint (PSTJ) injections.DesignSonographically guided procedures performed on cadaveric specimens.SettingProcedural skills lab at a tertiary medical facility.MethodsThree ultrasound‐guided approaches to inject the PSTJ: anterolateral, posteromedial, and posterolateral were derived based on anatomic review, published fluoroscopic and computed tomography (CT) techniques, and clinical experience. Three separate unembalmed cadaveric ankle‐foot specimens were injected by a single, experienced operator using a 25‐gauge, 38‐mm stainless steel needle. A different approach was used on each specimen. The needles were left in place and each specimen was subsequently dissected by co‐investigators to confirm accurate needle placement and determine the proximity of each needle to local tendons and neurovascular structures.Main Outcome MeasurementsDirect assessment of needle placement within posterior subtalar joint.ResultsAll 3 approaches provided accurate needle placement into the posterior subtalar joint while avoiding nearby tendinous and neurovascular structures.ConclusionsSonographically guided PSTJ injections are technically feasible. All 3 approaches provide accurate needle placement while minimizing the risk of needle entry into adjacent soft tissue structures not visualized by other modalities such as fluoroscopy or CT.
Prospective Pilot Study of Painful Lumbar Facet Joint Arthropathy after Intra‐articular Injection of Hylan G‐F 20
Authors: DePalma Michael J. , Ketchum Jessica M. , Queler Evan D. , Trussell Brian S. 
Published: October 2009

ObjectiveTo examine changes in pain, disability, and medication usage over time from baseline to up to 12 months after facet joint injection of hylan G‐F 20.DesignProspective, uncontrolled, pilot study.SettingUniversity spine center.ParticipantsFifteen patients (12 females), mean age of 57 years (standard deviation = 12.5), with a median duration of low back pain of 24 months (interquartile range = 11‐66).MethodsPatients who fulfilled inclusion criteria underwent diagnostic blocks with local comparative anesthetics at one unilateral facet joint (FJ). Those with a true positive response underwent 2 1.0‐mL intra‐articular hylan G‐F 20 injections, 10 days apart, into the painful FJ. A third hylan G‐F 20 injection was offered to patients dissatisfied with the results obtained with the first 2 injections.Main Outcome MeasuresVisual analog scale (VAS) (average, standing, walking), Oswestry Disability Index (ODI), SF‐36, finger to floor distance (FTF), tolerance (standing, sitting, walking), analgesic usage, and patient satisfaction collected at baseline, 7‐10 days, and at 1‐, 3‐, 6‐, and 12‐months follow‐up.ResultsRepeated measures mixed‐models indicated that VAS (average, standing, walking [P all < .005]), ODI (P = .029), SF‐36 (P = .013), FTF (P = .032), and sitting tolerance (P = .020) all showed significant changes from baseline up to 6 months and were not sustained at 12 months; with the exception of the baseline to 12‐month difference for FTF. There was not evidence of changes over time in standing (P = .085) or walking (P = .084) tolerance. Satisfaction initially increased from baseline (0%) to 7‐10 days (64%) but declined over time (36% at 12 months). As compared with baseline (80%), analgesic usage decreased nominally over time showing significant decreases at 6 months (33%, P = .0253) and increased slightly at 12 months (45%).ConclusionsViscosupplementation for lumbar FJ arthropathy with hylan G‐F 20 is associated with modest efficacy that predominately lasts up to 6 months. Limitations include a small sample size and lack of both a control and blinding. Larger, randomized, controlled studies are indicated to better clarify its clinical safety, efficacy, and utility.
Trunk Muscle Attributes Are Associated With Balance and Mobility in Older Adults: A Pilot Study
Authors: Suri Pradeep , Kiely Dan K. , Leveille Suzanne G. , Frontera Walter R. , Bean Jonathan F. 
Published: October 2009

ObjectiveTo determine whether trunk muscle attributes are associated with balance and mobility performance among mobility‐limited older adults.DesignCross‐sectional analysis of data from a randomized clinical trial.SettingOutpatient rehabilitation research center.ParticipantsCommunity‐dwelling older adults (N = 70; mean age 75.9 years) with mobility limitations as defined by the Short Physical Performance Battery (SPPB).MethodsIndependent variables included physiologic measures of trunk extension strength, trunk flexion strength, trunk extension endurance, trunk extension endurance, and leg press strength. All measures were well tolerated by the study subjects without the occurrence of any associated injuries or adverse events. The association of each physiologic measure with each outcome was examined by the use of separate multivariate models to calculate the partial variance (R2) of each trunk and extremity measure.Main Outcome MeasurementsBalance measured by the Berg Balance Scale and Unipedal Stance Test and mobility performance as measured by the SPPB.ResultsTrunk extension endurance (partialR2= .14,P= .02), and leg press strength (partialR2= .14,P= .003) accounted for the greatest amount of the variance in SPPB performance. Trunk extension endurance (partialR2= .17,P= .007), accounted for the greatest amount of the variance in BBS performance. Trunk extension strength (R2= .09,P= .03), accounted for the greatest amount of the variance in UST performance. The variance explained by trunk extension endurance equaled or exceeded the variance explained by limb strength across all three performance outcomes.ConclusionsTrunk endurance and strength can be safely measured in mobility‐limited older adults and are associated with both balance and mobility performance. Trunk endurance and trunk strength are physiologic attributes worthy of targeting in the rehabilitative care of mobility‐limited older adults.