bluuebunny/crossref_metadata_2025_split huggingface dataset:
How we do it: Diagrammatic recording of tympanomastoid procedures
Authors: Wasson J.D. , Kanegaonkar R.G. , Vaz F.M. , Thomas J.N. 
Published: December 2006

Keypoints• Accurate documentation of the operative findings of tympanomastoid procedures is essential for effective patient management and to satisfy the growing demands of clinical audit.• Due to the three‐dimensional complexity of the middle ear, it is difficult to represent graphically.• Consequently, most surgeons only describe subjectively their operative, otological findings.•We present for the first time a simple middle ear template which provides an objective tool to improve the recording of tympanomastoid procedures.
Multidimensional assessment of female tracheoesophageal prosthetic speech
Authors: Kazi R. , Kiverniti E. , Prasad V. , Venkitaraman R. , Nutting C.M. , Clarke P. , Rhys‐Evans P. , Harrington K.J. 
Published: December 2006

Objective:  The objective of this study was to undertake a multidimensional assessment of female tracheoesophageal prosthetic speech.Study Design:  A cross‐sectional cohort study.Setting:  Head and Neck Unit in a tertiary oncology referral centre.Patients:  Ten female and 10 male total laryngectomy patients with no signs of recurrence and using voice prosthesis were compared to 10 normal female speakers.Intervention(s):  Electroglottographic and acoustic analysis of voice parameters for both sustained vowel /i/ and connected speech, perceptual evaluation using GRBAS (with 2 experienced raters) and questionnaire assessment using the University of Washington Quality of Life and the Voice Handicap Index. Statistical analysis was done using the Statistical Package for Social Sciences, (v. 14, SPSS Inc., Chicago III).Results:  Median age of the female larygectomy patiemts was 65 years (range: 41‐81), that of male laryngectomees was 66.5 years (range: 40‐79) and that of the normal female subjects was 47.5 years (range: 35‐72). All electroglottographic, acoustic parameters and GRBAS ratings of the female laryngectomy patients were significantly worse as compared with the normal female subjects. The median fundamental frequency (111.8 Hz) was comparable to male tracheoesophageal speakers (115.8 Hz). Mean composite University of Washington Quality of Life score and overall Voice Handicap Index score was 79.3(12.5) and 47.5(27.6) for the female laryngectomy patients and for the males was 81.2 (9.6) and 39.4(18.7).Conclusions:  Gender frequency differences as seen in normal subjects are lost following a laryngectomy operation as evidenced by electroglottographic and perceptual data. Although the quality of life scores are comparable to the male tracheoesophageal speakers, they exhibit a greater voice handicap as compared to their male counterparts.
Changes in pulmonary dynamics in response to graded extrathoracic inspiratory resistive loading
Authors: Nouraei S.A.R. , Winterborn C. , Howard D.J. , Sandhu G.S. 
Published: December 2006

Objectives.  To investigate the impact of changes in inspiratory airway resistance on pulmonary dynamics as measured with flow‐volume phase plots under controlled conditions, to simulate the variable extrathoracic airway obstruction that commonly manifests in patients with sub‐glottic airway stenosis as a selective impediment to inspiratory airflow, to assess whether flow‐volume loops could provide quantitative physiological indices for the diagnosis and monitoring of this condition.Method.  We developed six selective inspiratory airway resistors by modifying Valsalva valves, and determined their airflow resistance characteristics using a flow‐pressure device. Maximum‐effort flow‐volume loops were recorded from fifteen healthy subjects, with the different inspiratory resistors, supplied at a random order, placed in series with the spirometer. The diagnostic and monitoring performances of the different indices derived from flow‐volume loops were assessed with Receiver Operator Characteristic plots, and Analysis of Variance respectively.Results.  The ratio between peak expiratory and inspiratory flows (PEF/PIF) had a sensitivity of 89% and a specificity of 70% for diagnosing extrathoracic obstruction, and could identify increases in airway resistance of over 10 cmH2O/s/L (P < 0.05; anova). The ratio of areas under the expiratory and inspiratory curves (AUCexpir/AUCinspir) of the flow‐volume loop provided the most sensitive index, with a sensitivity of 97.4%, and a specificity of 90.5%. Other previously‐reported indices, like the Empey ratio were significantly less sensitive.Conclusions.  Flow‐volume loop studies are non‐invasive and simple to perform, and can be used to add a quantitative physiological dimension to the initial diagnosis, and ongoing monitoring of patients with extrathoracic airway stenosis throughout treatment.
Characterisation of the bacterial flora of the larynx
Authors: Gillett S. , Rees L. , Coogan T. , Birchall M. , Bailey M. 
Published: December 2006

Objectives:  Damage to epithelial integrity has been implicated in inflammatory disease and neoplasia. Bacterial species such as Pseudomonas and Helicobacter have been shown to cause disease by tight cell junction breakdown and loss of epithelial integrity in the gut (1) There has been one description of the bacterial flora of the human larynx and its variation between individuals, using traditional culture techniques. (2) Sub‐site variation has not been characterised. We have compared methods of bacterial species identification and laryngeal sub‐site variation.Methods:  Bacteria were identified by sequencing of variable regions of the 16S RNA gene, obtained by PCR amplification of DNA from supra‐ and sub‐glottic laryngeal biopsies from pigs. Sequences were aligned with those of known bacteria using the blast nucleotide search engine. Concurrently, bacterial swabs from each larynx subsite were plated on to blood agar. Bacterial colonies isolated by this method were identified by 16S sequencing.Results:  A total of 6 Bacterial species were identified in the supra‐glottis compared to eight identified in the sub‐glottis by culture techniques. 10 bacterial species were identified in the supra‐glottis by cloning techniques, including fastidious species.Conclusion:  Bacterial species vary between supra and sub‐glottis.Cloning techniques are superior at identifying bacterial species when compared with traditional culture techniques.References 1 Sawada N et al. (2003) Med. Electron Microsc.36,147–1562 Tanaka I et al. (1996)Acta Otoloaryngol.525 (Suppl.), S44–50
MHC molecule expression in laryngeal epithelium of patients with laryngopharyngeal reflux compared to normal subjects
Authors: Birchall M. , Rees L. , Phillips A. , Johnston N. , Postma G. , Koufman J , Bailey M. 
Published: December 2006

Objectives.  We recently demonstrated an increase in the MHC‐associated molecule, β‐2‐microglobulin in laryngeal epithelium from patients with laryngopharyngeal reflux (LPR). This could not be accounted for by an increase in MHC Class I, particularly in the superficial layers where Class I is weakly expressed. We hypothesised that this reflected an increase in CD1d, a non‐classical MHC molecule.Methods.  Posterior laryngeal biopsies were obtained from 10 controls and 11 LPR patients. Multicolour immunofluorescence microscopy was used to measure expression of CD1d, CD161 (NK/NKT marker), CD4/8 T‐cells, macrophage, neutrophil and eosinophil antigens. Two‐way analysis of variance and unpaired T‐tests were performed on transformed data.Results.  Expression of CD1d increased from basal to superficial layers, and was marginally raised in LPR (P = 0.067), whilst CD161 increased significantly (P = 0.02). While CD161(+) cells were distributed throughout the epithelium, CD8(+) T‐cells were localised to the deep, MHC class I‐expressing layers. EMBP was significantly reduced in LPR (P = 0.01).Conclusions.  CD1d and MHC class I exhibit reciprocal expression patterns, which are reflected by the distribution of cells expressing their respective ligands (NKT cells and CD8(+) T‐cells). An increase in CD1d in LPR may be responsible for the increase in β‐2‐microglobulin observed, and is associated with a significant increase in NKT‐cells. The CD1d‐NKT cell axis may be a crucial part of maintaining tolerance in the laryngeal mucosa and changes in this system may be responsible for the persistence of inflammation in LPR.
Does the benefit of adenoidectomy in addition to ventilation tube insertion persist long‐term?
Authors: Daniel M. , Vaghela H. , Philpott C. , Thomas R.S.A. , Gannon M. , Spencer H. , Haggard M. 
Published: December 2006

Objectives.  TARGET randomised 376 children with persistent OME to 3 regimens: watchful waiting (WW), ventilation‐tubes only (VTO), and ventilation tubes‐adenoidectomy (VTA). At 2‐year follow‐up, the demonstrated greater benefits of VTA than VTO in terms of respiratory problems and hearing thresholds were still present. Records from the largest centre were examined to determine how long benefits of +adenoidectomy continue beyond 2 years.Methods.  Retrospective records analyses of Leicester children captured consultations and treatments outside the TARGET protocol, plus pure‐tone‐average (0.5–4 kHz) at latest clinical entry.Results.  Ninety‐four of 95 notes (99%) were available, with time‐lags of 7.5–11.6 years. On intention‐to‐treat analysis, children receiving treatment additional to allocation comprised 61% of WW, 59% of VTO, and 44% of VTA, with average surgical procedures numbering 1.0, 2.1, and 1.7. Proportions of children requiring >1 additional procedure were 13%, 34%, and 15%. Differences (VTO‐VTA) for consultations, operations and combined were marginal for this single centre but consistent with the significant all‐centre data for 3–6 years from randomisation. Mean latest pure‐tone‐averages were 15.84, 11.73, and 12.44 dBHL.Conclusions.  (1) Additional adenoidectomy has enduring benefits over VTO, although most clinical benefit appears to arise in the early years. (2) The two fifths of children randomised to WW not requiring surgery merit detailed epidemiological characterisation. (3) The benefits of surgery in OME are modest, requiring large‐number trials, but are genuine.
An autonomous surgical robot for drilling a cochleostomy–porcine trial
Authors: Coulson C.J. , Taylor R.P. , Griffiths M.V. , Proops D.W. , Brett P.N. 
Published: December 2006

Objectives.  Cochlea implantation involves drilling a cochleostomy through which the electrode array can be inserted. This is a freehand procedure requiring great accuracy. On breaking through the medial bony cochlea wall the drill penetrates through the endosteal membrane traumatizing the basilar membrane and scala tympani and contaminates them with bone dust. This probably causes a destruction of any residual hearing. Our objective was to produce an autonomous surgical drilling robot capable of drilling a cochleostomy but stopping prior to disrupting the endosteal membrane.Method.  The autonomous surgical robot senses the force and torque at the tool point and uses this information to predict the start of breaking through the medial bony cochlea wall. Drilling is stopped prior to penetrating the endosteal membrane. The autonomous robot was used to drill a cochleostomy in 5‐porcine cochlea's.Results.  In all 5 procedures the autonomous surgical drilling robot stopped at the point of breakthrough. The endosteal membrane was not perforated in any of the specimens. The intact membrane was visible at the base of the cochleostomy.Conclusions.  The autonomous surgical robot can drill a cochleostomy that minimizes damage to the membranous cochlea. The effect of this increased accuracy on residual hearing and post‐operative infection is under further investigation.
Anatomical characterisation of voltage gated sodium channels in the mammalian cochlear nerve spiral ganglia
Authors: Prasai A. , Mulheran M. , Grubb B.D. 
Published: December 2006

Introduction.  There is evidence that Voltage Gated Sodium Channels (VGSC) may represent novel therapeutic targets for treatment of certain types of tinnitus and hearing loss. It is also known that the different VGSC types vary in their affinity for differing VGSC blockers. Parallels have been drawn with certain types of tinnitus, chronic pain and epilepsy (1) These conditions are thought to arise from pathological VGSC activity (2) There has also been empirical interest in the use of VGSC blockers as tinnitolytics, with the best known of these being intravenous lignocaine.Aim.  The aim of this study was first begin to characterise VGSCs in the mammalian cochlear nerve spiral ganglion.Method.  After sacrifice, guinea pigs were perfused with heparin and then 2% paraformaldehyde. The bony matrix of the cochleae was decalcified in buffer containing EGTA (8%). Decalcified tissues were embedded; frozen and 20‐micron cryosections were made through the cochleae. Immunocytochemistry was then carried out using antibodies that selectively bind to individual sodium channel α‐subunits. Sections were then analysed and photographed using either an epifluorescence or a confocal microscope.Results and Conclusions.  Sodium channel type 1.6 and 1.7 were shown to be expressed in the cochlear nerve spiral ganglion. Further work is being carried out to see if there are changes in the expression of these VGSC after ototrauma. These findings may help us to target our therapy to treat certain types of tinnitus and hearing loss.References 1 Smith P.F., Darlington C.L. (2005) Drug treatments for subjective tinnitus: serendipitous discovery versus rational drug design. Curr. Opin. Investig. Drugs.6, 712–7162 Taylor C.P., Meldrum B.S. (1995) Na+ channels as targets for neuroprotective drugs. Trends. Pharmacol. Sci. 16, 309–315
N‐terminal pro‐brain natriuretic peptide used for the prediction of coronary artery stenosis
Authors: Wolber T. , Maeder M. , Rickli H. , Riesen W. , Binggeli C. , Duru F. , Ammann P. 
Published: December 2006

AbstractBackground  The level of the inactive N‐terminal fragment of pro‐brain (B‐type) natriuretic peptide (NT‐proBNP) is a prognostic marker in patients with acute and chronic coronary artery disease (CAD). It might also be valuable for non‐invasive diagnosis of coronary artery disease.Materials and methods  The NT‐proBNP was measured in 781 consecutive patients with normal left ventricular function referred for coronary angiography owing to symptoms or signs of CAD. The diagnostic value of NT‐proBNP was assessed for predicting CAD at angiography.Results  Elevated NT‐proBNP levels were associated with the extent of CAD and with the female sex (P < 0·001). The ability of NT‐proBNP to predict significant coronary disease at angiography was assessed separately for men using a cut‐off point of 85 pg mL−1, positive likelihood ratio 2·2 (95% CI, 1·7–3·0), negative likelihood ratio 0·53 (95% CI 0·45–0·63) and area under the receiver‐operating‐characteristic (ROC) curve 0·72: for women, it was assessed using a cut‐off point of 165 pg mL−1, positive likelihood ratio 2·4 (95% CI, 1·7–3·4), negative likelihood ratio 0·55 (95% CI, 0·44–0·70) and area under ROC curve 0·71. In multiple logistic‐regression analysis, NT‐proBNP added significant independent predictive power to other clinical variables in models predicting CAD (odds ratio 2·76, 95% CI, 1·76–4·32, P < 0·001).Conclusions  The NT‐proBNP is a marker of non‐obstructive CAD and of significant coronary stenosis. In conjunction with other clinical information, measurement of NT‐proBNP with the use of sex‐specific reference ranges may improve the non‐invasive prediction of CAD.
Effects of cardioversion of atrial fibrillation on endothelial function in hypertension or diabetes
Authors: Guazzi M. , Belletti S. , Lenatti L. , Bianco E. , Guazzi M. D. 
Published: December 2006

AbstractBackground  Cardioversion (CV) to sinus rhythm corrects endothelial dysfunction secondary to atrial fibrillation (AF). As AF often complicates hypertension and diabetes (disorders associated with impaired endothelial function) the study probed whether these comorbidities to AF produced an additive effect and to what extent CV might be advantageous.Materials and methods  Brachial artery flow‐mediated dilatation (FMD) was evaluated before and after CV in 17 lone AF patients (group 1), 16 patients with AF + hypertension (group 2) and 17 patients with AF + diabetes type II (group 3), while in supine and head‐up tilting (HUT) positions, as this is when endothelial vasodilation is emphasized as a counterbalance to neurogenic vasoconstriction.Results  After 2 weeks, CV in group 1 increased (P < 0·01) supine FMD (from 7·22→9·50%) and restored its HUT potentiation (from 9·31→17·22%). In group 2, FMD also improved significantly with CV (supine from 4·92→7·11% and HUT from 5·29→11·83%; P < 0·01). In group 3, CV did not promote significant FMD changes (supine from 5·12→4·92% and HUT from 4·98→4·73%). After 3 months, FMD improvement persisted in groups 1 and 2 with enduring sinus rhythm, but not in those with AF relapse. In group 3, FMD remained unchanged regardless of cardiac rhythm.Conclusions  Cardioversion persistently increases supine shear stress endothelial responsiveness and restores the orthostatic modulation in AF alone or in association with hypertension, but not with diabetes. Differences in background endothelial impairment may explain the presence (hypertension) or the absence (diabetes) of an additive AF effect in comorbidities, as well as CV results.
Serum concentrations of the tissue polypeptide specific antigen in patients suffering from non‐alcoholic steatohepatitis
Authors: Tarantino G. , Conca P. , Coppola A. , Vecchione R. , Di Minno G. 
Published: December 2006

AbstractBackground Liver histology is the gold standard for diagnosis of non‐alcoholic fatty liver disease. Ethical considerations and patient choice often preclude performing a liver biopsy, especially considering the rare but potential risk. Searching for a good serological marker substitute for the invasive procedure was the aim of our study. Keratins, mainly 8 and 18, play not only a mere structural role providing mechanical stability to hepatocytes, but also represent a target via toxic stress ultimately inducing apoptosis/necrosis. Tissue polypeptide‐specific antigen (TPS), a serological mirror of keratin 18, is widely used as a marker for various cancers. This antigen was assessed in three different groups who were overweight or obese.Materials and methods In this cross‐sectional case–control study, 48 cancer‐free patients with non‐alcoholic steatohepatitis (NASH, Group 1), 48 patients with pure fatty liver (FL, Group 2), and 47 volunteers (Group 3) were studied. All of them were referred to our metabolic unit for routine evaluation.Results The median (range) TPS levels were 123 (56–286) ng mL−1in NASH patients. FL patients and volunteers had significantly lower TPS levels, 76 (38–98) ng mL−1and 64 (28–87) ng mL−1, respectively (P = 0·0001). A value of 88 ng mL−1in patients with underlying bright liver was associated with a high probability of NASH (sensitivity and specificity = 92% and 96%, respectively). One patient (2·1%) with FL had a TPS value > 88 ng mL−1, but in the same group, 29 FL patients (60·4%) had an alanine aminotransferase value > 40 U L−1. Based on a recent classification of liver fibrosis, the median (range) TPS values were significantly different among the stages:F1 (n = 23) = 100 (76–264) ng mL−1;F2 (n = 21) = 134 (56–276) ng mL−1; andF3 (n = 4) = 199·5 (123–286) ng mL−1, respectively (P = 0·014).Conclusions Our study shows that TPS is a better marker than alanine aminotransferase activity, ultrasonography or the combination of both parameters in differentiating NASH from FL.
Invertebrate responses to short‐term water abstraction in small New Zealand streams
Authors: DEWSON ZOË S. , JAMES ALEXANDER B. W. , DEATH RUSSELL G. 
Published: December 2006

Summary1. Small permanent streams are coming under increasing pressure for water abstraction. Although these abstractions might only be required on a short‐term basis (e.g. summer time irrigation), the highest demand for water often coincides with seasonal low flows.2. We constructed weirs and diversions that reduced discharge in three small streams (<4 m width) to test the hypotheses that short‐term water abstractions would decrease habitat availability and suitability for invertebrates, resulting in increased invertebrate drift, reduced taxonomic richness and decreased benthic invertebrate densities.3. We sampled benthic invertebrates, invertebrate drift and periphyton at control (upstream) and impact (downstream) sites on each stream before and during 1 month of discharge reduction.4. Discharge decreased by an average of 89–98% at impact sites and wetted width decreased by 24–30%. Water depth decreased by 28–64% while velocity decreased by 50–62%. Water conductivity, temperature and dissolved oxygen showed varying responses to flow reduction among the three streams, whereas algal biomass and pH were unaffected in all streams.5. The densities of invertebrate taxa tended to increase in the impact reaches of these streams, even though invertebrate drift increased at impact sites in the first few days following discharge reduction. There were a higher proportion of mayflies, stoneflies and caddisflies at the impact site on one stream after flow reduction. There were no changes to the number of taxa or species evenness at impact sites.6. Our results suggest that for these small streams, the response of invertebrates to short‐term discharge reduction was to accumulate in the decreased available area, increasing local invertebrate density.
Geostatistical modelling on stream networks: developing valid covariance matrices based on hydrologic distance and stream flow
Authors: PETERSON ERIN E. , THEOBALD DAVID M. , VER HOEF JAY M. 
Published: December 2006

Summary1. Geostatistical models based on Euclidean distance fail to represent the spatial configuration, connectivity, and directionality of sites in a stream network and may not be ecologically relevant for many chemical, physical and biological studies of freshwater streams. Functional distance measures, such as symmetric and asymmetric hydrologic distance, more accurately represent the transfer of organisms, material and energy through stream networks. However, calculating the hydrologic distances for a large study area remains challenging and substituting hydrologic distance for Euclidean distance may violate geostatistical modelling assumptions.2. We provide a review of geostatistical modelling assumptions and discuss the statistical and ecological consequences of substituting hydrologic distance measures for Euclidean distance. We also describe a new family of autocovariance models that we developed for stream networks, which are based on hydrologic distance measures.3. We describe the geographical information system (GIS) methodology used to generate spatial data necessary for geostatistical modelling in stream networks. We also provide an example that illustrates the methodology used to create a valid covariance matrix based on asymmetric hydrologic distance and weighted by discharge volume, which can be incorporated into common geostatistical models.4. The methodology and tools described supply ecologically meaningful and statistically valid geostatistical models for stream networks. They also provide stream ecologists with the opportunity to develop their own functional measures of distance and connectivity, which will improve geostatistical models developed for stream networks in the future.5. The GIS tools presented here are being made available in order to facilitate the application of valid geostatistical modelling in freshwater ecology.