bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does surgical treatment improve behaviour in OME?
Authors: Haggard Mark ,   MRC Multi‐centre Otitis Media Study Group
Published: May 2006

Background. For older children with OME, the acknowledged presentation includes behaviour problems. However, it has never been specified which aspects of behaviour are most affected, nor whether treatments improving physical health and hearing (efficacy) also improve such indirect outcomes (effectiveness). Methods. We developed a parent‐reported, age‐appropriate, 18‐item measure (BEH‐18) of developmental behaviour problems and showed it to be affected by otitis media with effusion (OME) in a large‐sample case‐control comparison. (SD effect size 0.72, both ns >500) Correlations with hearing level (HL) and ear infection scores in cases showed a maximum with behaviour lagging in time by at least 3 months. The TARGET database offers follow‐up times 6 and 12 months after randomisation so provides a fair test of benefits from ventilation tubes (VTs – grommets). We pooled over grommets‐alone and grommets plus adenoidectomy (+ad), as +ad showed no effects on BEH‐18. We adjusted for baselines and for expectancy and halo biases by analysis of covariance. On top of the usual attendance bias with sample attrition, a social desirability reporting bias in offspring's behaviour and the lagged outcome period led to much missing data, making imputation essential. We partially imputed the two‐occasion outcome for missing data by simple part‐whole regression, raising the used sample from 263 with complete data on all variables to 328 (70 up to 87% of the 376 randomised). Results. An unimputed analysis with the most favourable bias adjustment, admitting some earlier beneficial effects on HL and ear infections into the estimated treatment effect suggested a marginally significant reduction in behaviour problems (P = 0.14, 0.15 for 6 and 12 months). However with the same favourable adjustment, the combined and imputed analysis produced a Bias‐adjusted Treatment Effect Size (BaTES) of only 0.10 SD (P = 0.423). It is known, and increasingly heeded, that misleading results (in either direction) can be obtained in trials that fail to impute for missing data (when over about 10% of cases). Conclusions. Wider benefits from grommets (beyond those to hearing and ear infections) exist but those are limited and do not include benefits to behaviour, so should not be oversold.
Event related potentials – are they useful in paediatric cochlear implant patients?
Authors: Singh S. , Liasis A. , Rajput K. , Luxon L. 
Published: May 2006

Background. The use of cochlear implants in profoundly deaf children is increasing with a trend towards earlier implantation. However, tools used at present to assess outcome are primarily based on behavioural tests, which are difficult to use effectively in young children. Event related potentials (ERP) such as Mismatch Negativity (MMN) have been proposed to have potential in assessing central processing in cochlear implant patients.1 Objective. The main objective of this study was to assess the correlation of ERP measures with behavioural assessment data to identify if they can be used to predict performance in cochlear implant patients. Methods. We carried out a prospective, blinded, non‐randomised study investigating auditory ERPs to speech stimuli in 35 cochlear implanted children. We compared P1, N2 and MMN parameters with behavioural outcome, assessed at the time of recording ERPs and 2 years later. Results. Auditory ERPs were identifiable in 30 out of 35 patients. MMN was recorded in 85% of star performers but in only 20% of poor performers. At behavioural reassessment 2 years later, 50% of poor performers who had demonstrated a MMN progressed to achieve ‘star’ performance in comparison to 25% of those who had not. Conclusion. These results indicate that MMN can be used to assess the functional status of auditory cortex in young children with cochlear implants and may provide an objective measure to predict future performance. However a large longitudinal study is needed to establish its sensitivity and specificity before using it as a clinical tool. Reference 1 Singh S., Liasis A., Towell A., et al. (2004) Event related potentials in cochlear implant patients. Ear and Hearing25(6), 598‐‐610
Can symptoms patterns distinguish patients with post‐nasal drip, reflux or globus?
Authors: Cathcart R.A. , Steen I.N.S. , Ali K.H.M. , McInally K.G. , Wilson J.A. 
Published: May 2006

The Glasgow Edinburgh Throat scale (GETS) was developed to assess severity and therapy outcomes in globus sensation. The Reflux Symptom Index (RSI) was similarly derived to assess the possible spectrum of cervical symptoms due to laryngopharyngeal reflux. Both were physician derived tools with little published data on their factor structure, and nothing published to date on their ability to generate whether or not they capture similar pharyngeal phenomena. Aim. To assess the consistency and factor structure of the two questionnaires. Methods. Subjects completing: both questionnaires 134 catarrh clinic patients; RSI only: 32 chronic chest clinic attenders; GETS only 168 volunteer ophthalmology outpatients. All items of both questionnaires were stored in SPSS. The analysis included Cronbach's α, correlation coefficients, Scree slope plots with derivation of Eigenvalues, principal components analysis using Varimax rotation with Kaiser Normalisation. Results. The GETS was completed by 302 subjects (Cronbach's α = 0.81, confirming good internal consistency of the scale overall. Three factors were identified which accounted for over 70 % of the total variance. Factor 1 was much the strongest (49% of the total variance) and included ‘catarrh’ or post‐nasal drip, globus, can't empty throat, continually want to swallow, irritation. Factor 2 had obstructive items‐ dysphagia, food sticking / throat closing. Factor three was a 2 item pain and swelling component. The RSI was completed by 168 individuals, also with acceptable overall consistency (α = 0.72). The optimum factorisation showed 2 main factors: (i) The first (α = 0.71) included coughing, choking, difficulty swallowing and heartburn/dyspepsia. (ii) The second appeared mostly to reflect post‐nasal drip and included catarrh, throat clearing, globus, and voice disorder (α = 0.62). Finally we performed a combined analysis of all 19 items – 10 GETS and nine RSI – derived from 134 subjects. This showed that heartburn mapped poorly to the overall combined factor structure which, as might be now predicted, showed factors similar to the two component tools – i.e. (i) obstruction / cough; (ii) post‐nasal drip / clearing the throat. Conclusion. The RSI and GETS emerge as reliable tools of symptom intensity: but what do these symptoms actually indicate? Both tools generate principal domains of ‘cough and block’ and ‘globus/drip/throat clearing’. In other words RSI and GETS both appear to identify similar symptom patterns, nor can the place of symptomatic gastro‐oesophageal reflux be clarified from the history. Indeed it appears that there can be little specific aetiological inference from the isolated assessment of post‐nasal or pharyngeal symptoms. References 1 Deary I.J., Wilson J.A. et al. (1995) J Psychosom Res. 39, 203–2132 Belafsky P.C., Postma G.N. & Koufman J.A. (2002) Validity and reliability of the reflux symptom index (RSI). J Voice16, 274–277
Sadé and Tos classifications of the tympanic membrane: not reliable?
Authors: Pothier D. 
Published: May 2006

Objectives. Retraction pockets of the tympanic membrane may progress to cholesteatoma.1 To assess and describe the condition of retraction pockets and to monitor their progress, classification systems are used; this classification is of particular importance when follow‐up is conducted by more than one clinician. The Sadé classification is used for the pars tensa and the Tos classification system for the pars flaccida. Although widely used, neither method has been validated or evaluated for reliability when applied by different users. Method. A series of 20 standardised slides of retraction pockets (10 each of PT and PF retractions) was shown to 22 Otolaryngologists. Participants were asked to classify each lesion using the appropriate classification according to supplied, printed definitions. Results. Overall inter‐rater reliability was very low (mean kappa of 0.39), with very high levels of variability. Levels of agreement between raters was lower when classifying PF retractions than PT retractions (P = 0.01). No slide was classified unanimously as a single grade. Some slides even had an equal distribution of classifications spread between all grades of the classification system. No significant difference in inter‐rater reliability was found between grades (P = 0.7). Conclusions. This is the first attempt at validation of the Tos and Sadé classification systems for retraction pockets. Despite the reliance on classification of retraction pockets, it would appear from this study that the value of these classification systems may be limited. Clinical decisions based on classifications may be flawed, particularly when made on the basis of a classification made by another clinician. Reference 1 Akyildiz N., Akbay C., Ozgirgin O.N., et al. (1993) The role of retraction pockets in cholesteatoma development: an ultrastructural study. Ear Nose Throat J.72, 210‐‐212
Variations in the application procedures for the specialist registrar post in otolaryngology
Authors: Doshi J. , Anari S. 
Published: May 2006

Objective. To compare the application process and person specification requirements for each deanery in the United Kingdom for a Type I specialist registrar post in otolaryngology. Method. All 18 deaneries listed by the Joint Committee of Higher Surgical Training were contacted by email to send their most up to date person specification, job description and details of their application process. Those deaneries that did not respond were contacted by telephone. The person specification, application process and content of the application forms from each deanery were critically reviewed and compared. Results. 14/18 deaneries responded; four classified the information requested as confidential. Results included (number of deaneries in brackets): Application method: application form (8), curriculum vita (3), both (3). Submission method: post (13), e‐mail (1). Examples of the variable degree of objective assessment of achievements included: prizes (9), temporal bone course (2), validated logbook (6), peer‐review publications as essential (3), European Computer Driving License (2). Publication, presentation, audit, medical/surgical courses, management and Membership of a Royal College of Surgeons (MRCS) were the only common themes amongst all deaneries. Conclusions. There was a wide variation in the application process and the information wanted by different deaneries. Many criteria within the person specification were not objectively assessed. With the introduction of modernising medical careers (MMC) and the change in higher surgical training, deaneries will need to re‐examine their application process and criteria. A nationally agreed application form and process should be considered to provide a more objective measure of distinguishing between applicants.
2‐Dimensional gel electrophoresis and MALDI‐MS of cystic cervical metastasis from head and neck squamous cell carcinoma
Authors: Beer H.L. , Jenkins R.E. , Gutowska‐Owsiak D. , Pazmany L. , Birchall M.A. , Kitteringham N.R. 
Published: May 2006

Objectives. Proteomics could provide important insights into pathogenesis and potential new targets for diagnosis, prognosis, prediction and therapy for head and neck squamous cell carcinoma (HNSCC). However, study of solid tissue is problematic.1 Cystic degeneration that occurs in advanced nodal metastasis can be difficult to differentiate from benign disease, especially in the absence of primary tumour.2 As with other malignant effusions, HNSCC cystic fluid may prove a rich source of novel tumour associated proteins: possible targets for immunotherapy, diagnosis, prediction or prognosis. Design. Feasibility study of 2D‐gel electrophoresis (2DGE) and matrix‐assisted laser desorption‐ionisation mass spectrometry (MALDI‐MS) to analyse cyst fluid within squamous metastasis. Method. Cystic fluid was aspirated from a cervical metastasis in a patient with advanced squamous cancer. Proteins were separated by 2DGE, stained with Coomassie brilliant blue and identified by MALDI‐MS. Results. Initial analysis showed an abundance of haemoglobin, albumin and immunoglobulin, as expected. The gel also revealed unexpected proteins, particularly periredoxin‐2. There were also some unidentified spots, possibly containing novel proteins. In order to increase the potential for identifying lower abundance proteins, albumin and immunoglobulin were depleted by affinity chromatography and further 2DGE undertaken. Conclusions. 2DGE is applicable to the study of fluid from cystic cervical metastases. Unexpected proteins identified in this pilot study require confirmation in a larger series. Depletion of abundant proteins will allow unidentified spots to be characterised. These approaches are likely to open a new window to proteins ‘at the coal‐face’ of head and neck cancer. References 1 Wu W., Tang X., Hu W., et al. (2002) Clin. Exp. Metastasis19, 319‐‐3262 Raghavan U. & Bradley P.J. (2003) Curr. Opin. Otolaryngol. Head Neck Surg. 11(2), 124‐‐128
PTTG promotes a novel VEGF‐KDR‐ID3 autocrine mitogenic pathway in thyroid cancer
Authors: Kim D.S. , Buchanan M.A. , Stratford A.L. , Watkinson J.C. , Eggo M.C. , Franklyn J.A. , McCabe C.J. 
Published: May 2006

Background. VEGF exerts its effects by binding to tyrosine kinase receptors, KDR and VEGFR1. KDR is critical for transmitting signals for proliferation of endothelial cells but is also expressed in several non‐endothelial cells suggesting existence of autocrine stimulatory pathways. Study‐design. We investigated VEGF and KDR expression in human thyroid epithelial cells in vitro and thyroid cancers samples ex vivo. Results. Expression of KDR was demonstrated using Taqman RT‐PCR and Western blotting in a human follicular thyroid cancer line (FTC133) and primary thyroid epithelial cells. Further, VEGF‐specific and dose‐dependent activation of KDR‐dependent MAPK signalling and KDR‐dependent mitogenesis was demonstrated. KDR mRNA expression was elevated in thyroid cancers (2.5‐fold, n = 38, P < 0.001), and immunohistochemistry demonstrated stronger phosphorylated‐KDR staining in thyroid cancer cells. Further, we showed that PTTG, an oncogene known to promote angiogenesis, up‐regulates KDR (2.2‐fold, P = 0.006) and VEGF (2.4‐fold, P < 0.001) expression in FTC133 thyroid cells. Next, we examined expression of ID3, known to be important in VEGF‐dependent angiogenesis, and VEGF mRNA expression in a series of thyroid cancers. We observed a strong positive correlation between expression of these genes (R2 = 0.62, P < 0.001). Stimulation of FTC133 cells with exogenous VEGF increased ID3 expression (2.1‐fold, P < 0.001), an effect abrogated by a KDR‐specific inhibitor, suggesting VEGF regulation of ID3 is KDR‐dependent. Conclusion. We suggest the presence of a VEGF‐KDR‐ID3 dependent autocrine pathway in thyroid cells. By up‐regulating both VEGF and KDR expression, we propose that PTTG may promote this autocrine proliferative pathway which may in turn be critical to thyroid cancer progression.
The role of lung resistance protein in radiation treated head and neck carcinoma
Authors: Silva P. , Slevin N. , Sloan P. , Price P. , West C. , Homer J. , Hampson I. , Hampson L. 
Published: May 2006

Objectives. Vault proteins are ribonucleotide proteins composed largely of a single large protein termed major vault protein. (MVP) The (MVP) LRP gene is located on chromosome 16 close to the genes coding for multidrug resistance‐associated protein and protein kinase c‐β. The role of MVP (LRP) in cancer drug resistance has been demonstrated in various cell lines as well as in ovarian carcinomas and acute myeloid leukaemia, however little is known about its possible role in radiation resistance.1,2 Our aim was to examine this in head and neck squamous carcinoma (HNSCC). Method. One hundred and thirty three patients with proven squamous cell carcinoma of the oropharynx were recruited into the study, looking at two subsites of posterior tongue and tonsil. These patients received primary radiotherapy with curative intent. Archived biopsy material was obtained for 78 patients. Immunohistochemistry was used to detect LRP expression. Locoregional failure and cancer specific survival were estimated using Kaplan Meier method. Results. On analysis of the whole group together LRP expression was strongly associated with locoregional failure (P < 0.0001) however, on subgroup analysis there was an obvious difference between the two sites, with increased LRP expression being associated with poor prognosis in the tongue group (P < 0.0001), but not the tonsil group. (P = 0.14). Conclusion. This is the first reported study of LRP as a prognostic marker in radiotherapy treated HNSCC suggesting it may play an important role not just in cancer drug resistance but also in radiation resistance. Of added interest is the difference in prognostic significance between the two subsites. References 1 Scheffer G.L., Wijngaard P.L., Flens M.J., et al. (1995) The drug resistance‐related protein LRP is the human major vault protein. Nature Med.1, 578–5822 Kozlov G., Vavelyuk O., Ovidiu M., et al. (2005) Solution structure of a two‐repeat fragment of major vault protein. J. Mol. Biol.7
A randomised controlled trial comparing rapid rhino with netcell packs after routine nasal surgery
Authors: McDonald S. , Slater J. , Garth R. 
Published: May 2006

Objectives. To determine whether there is a difference in discomfort between Netcell and Rapid Rhino (RR) packs following routine nasal surgery. Methods. LREC approval for the study was granted. Patients aged 16‐‐65 undergoing septal and inferior turbinate surgery, who did not meet the exclusion criteria, were approached for consent to participate in the trial. Post‐operatively, one nasal cavity was packed with Netcell, and the other with Rapid Rhino (a methodological design used by Arya et al.1). The type of pack inserted on the left side was decided using sequentially numbered opaque envelopes, which were block‐randomised in groups of 4 and 8. By default, the pack used for the right nasal cavity was the other type. Nursing staff removed the packs at 7 am the following day. Prior to and immediately following removal, patients recorded their pain scores for each side on a standard 100 mm visual analogue scale. The left pack was always removed first. A power calculation ensured that enough patients were recruited to provide 90% power for a difference in VAS of 10 mm with a se of 20 mm at the 5% significance level. Results. Primary outcome: RR was significantly more painful on removal than netcell (difference = 10.6 mm, P < 0.001, Wilcoxon signed ranks test). Secondary outcome: There was no significant difference in mean VAS for the packs in situ. One Netcell pack was removed due to bleeding, and replaced with Merocel. Conclusion. The packs are equally comfortable in situ, and RR is more painful on removal. Reference 1 Arya A.K., Butt O. & Nigam A. (2003) Double‐blind randomised controlled trial comparing Merocel with rapid rhino nasal packs after routine nasal surgery. Rhinology41, 241‐‐243
Cognitive deterioration associated with an expedition in an extreme desert environment
Authors: Maruff P , Snyder P , McStephen M , Collie A , Darby D 
Published: May 2006

Background:Prolonged exposure to extreme environments may result in cognitive changes that may influence decision making ability and increasing risk of injury or death.Objective:To measure the cognitive performance of a healthy man as he completed a 17 day desert expedition.Method:A computer based cognitive test battery, subjective cognitive rating scale, and measures of physical characteristics were used. Objective cognitive performance was compared with the performance of eight age matched men who remained in their own homes.Results:The speed of psychomotor, attentional, and executive functions decreased as the expedition progressed, but the accuracy of performance remained unaffected. Although some impairments were large, they resolved completely once the expedition was completed. Subjective ratings indicated that the subject had insight into his failing cognitive performance during the expedition.Conclusions:Cognitive performance can be measured repeatedly throughout an expedition in an extreme environment. Cognitive impairment may occur.
The effects of creatine supplementation on selected factors of tennis specific training
Authors: Pluim B M , Ferrauti A , Broekhof F , Deutekom M , Gotzmann A , Kuipers H , Weber K 
Published: May 2006

Background:Creatine supplementation is popular among tennis players but it is not clear whether it actually enhances tennis performance.Objectives:To examine the effects of creatine supplementation on tennis specific performance indices.Methods:In a randomised, double blind design, 36 competitive male tennis players (24 creatine, mean (SD) age, 22.5 (4.9) years; 12 placebo, 22.8 (4.8) years) were tested at baseline, after six days of creatine loading, and after a maintenance phase of four weeks (14 creatine, 10 placebo). Serving velocity (10 serves), forehand and backhand velocity (three series of 5×8 strokes), arm and leg strength (bench press and leg press), and intermittent running speed (three series of five 20 metre sprints) were measured.Results:Compared with placebo, neither six days nor five weeks of creatine supplementation had a significant effect on serving velocity (creatine: +2 km/h; placebo: +2 km/h, p = 0.90); forehand velocity (creatine: +4 km/h; placebo: +4 km/h, p = 0.80), or backhand velocity (creatine: +3 km/h; placebo: +1 km/h, p = 0.38). There was also no significant effect of creatine supplementation on repetitive sprint power after 5, 10, and 20 metres, (creatine 20 m: −0.03 m/s; placebo 20 m: +0.01 m/s, p = 0.18), or in the strength of the upper and lower extremities.Conclusions:Creatine supplementation is not effective in improving selected factors of tennis specific performance and should not be recommended to tennis players.
Stress fractures of the femoral shaft in athletes: a new treatment algorithm
Authors: Ivkovic A , Bojanic I , Pecina M 
Published: May 2006

Background:Femoral shaft stress fractures in athletes are not common but pose a great diagnostic challenge to clinicians. Because of few clinical signs, diagnosis and treatment are often delayed. Furthermore, if not treated correctly, these fractures are well known for complications and difficulties.Objective:To develop a well structured and reproducible treatment algorithm for athletes with femoral shaft stress fractures.Methods:The proposed algorithm is carried out in four phases, each lasting three weeks, and the move to the next phase is based on the result of the tests carried out at the end of the previous phase. Over nine years, we treated seven top level athletes, aged 17–21. In all athletes, diagnosis was based on physical examination, plain radiographs, and bone scan.Results:As a result of the treatment method, all the athletes were fully engaged in athletic activity 12–18 weeks after the beginning of treatment. After completion of the treatment, the athletes were followed up for 48–96 months. During the follow up, there was no recurrence of discomfort or pain, and all the athletes eventually returned to competition level.Conclusion:These results and data available from the literature suggest that the algorithm is the optimal treatment protocol for femoral shaft stress fractures in athletes, avoiding the common complications and difficulties.