bluuebunny/crossref_metadata_2025_split huggingface dataset:
Genes involved in radiation therapy response in head and neck cancers
Authors: Dumur Catherine I. , Ladd Amy C. , Wright Harry V. , Penberthy Lynne T. , Wilkinson David S. , Powers Celeste N. , Garrett Carleton T. , DiNardo Laurence J. 
Published: January 2009

AbstractObjectives:This is a pilot study designed to identify gene expression profiles able to stratify head and neck squamous cell carcinoma (HNSCC) tumors that may or may not respond to chemoradiation or radiation therapy.Study Design:We prospectively evaluated 14 HNSCC specimens, arising from patients undergoing chemoradiotherapy or radiotherapy alone with curative intent. A complete response was assessed by clinical evaluation with no evidence of gross tumor after a 2‐year follow‐up period.Methods:Residual biopsy samples from eight complete responders (CR) and six nonresponders (NR) were evaluated by genome‐wide gene expression profiling using HG‐U133A 2.0 arrays. Univariate parametric t‐tests with proportion of false discoveries controlled by multivariate permutation tests were used to identify genes with significantly different gene expression levels between CR and NR cases. Six different prediction algorithms were used to build gene predictor lists. Three representative genes showing 100% crossvalidation support after leave‐one‐out crossvalidation (LOOCV) were further validated using real‐time QRT‐PCR.Results:We identified 167 significant probe sets that discriminate between the two classes, which were used to build gene predictor lists. Thus, 142 probe sets showed an accuracy of prediction ranging from 93% to 100% across all six prediction algorithms. The genes represented by these 142 probe sets were further classified into different functional networks that included cellular development, cellular movement, and cancer.Conclusions:The results presented herein offer encouraging preliminary data that may provide a basis for a more precise prognosis of HNSCC, as well as a molecular‐based therapy decision for the management of these cancers. Laryngoscope, 119:91–101, 2009
Iatrogenic esophageal submucosal dissection after attempted diagnostic gastroscopy (with videos)
Authors: Tang Shou‐jiang , Tang Linda , Jazrawi Saad F. , Meyer Dan , Wait Michael A. , Myers Larry L. 
Published: January 2009

AbstractDiagnostic esophagogastroduodenoscopy (EGD) is generally a very safe procedure. We report the first case of iatrogenic esophageal submucosal dissection after an attempted diagnostic gastroscopy in a patient with a small previously undiagnosed Zenker's diverticulum (ZD). After EGD, she developed severe dysphagia with the inability to swallow solids, liquids, and even her own saliva. On barium swallow study, there was a column of contrast below the upper esophageal sphincter, and this was misdiagnosed as a large ZD by the radiologist. The resultant stricture was successfully managed with endoscopic balloon dilatation under fluoroscopy with wire‐guided cannulation. The ZD was treated with flexible endoscopic clip‐assisted diverticulotomy. Iatrogenic submucosal dissection is a unique complication of upper endoscopy. Endoscopists, otolaryngologists, radiologists, and cardiothoracic surgeons should be aware of this condition and prepare to manage it appropriately. If the patient is stable and the possibility of perforation is small, conservative and supportive care can be tried first. A surgical gastrostomy tube can be placed for enteral feeding. In patients with ZD, ZD recognition and gentle manipulation is strongly recommended during esophageal intubation. Laryngoscope, 119:36–38, 2009
Transforming growth factor‐β1 shows an incremental osteoinductive dose‐response relationship
Authors: Moxham J. Paul , Wong Kevin K. , Kibblewhite Douglas J. 
Published: January 2009

AbstractObjective:To determine if there is a dose–response curve for TGF‐β1 in a rabbit calvarial defect model.Study Design:Controlled animal study using arms of increasing concentrations of TGF‐β1 to evaluate the osteoinductive potential of each arm.Methods:Sixteen skeletally mature New Zealand white rabbits were randomized into control and experimental arms. Incremental doses of TGF‐β1 delivered in an inactivated guanidine‐extracted demineralized bone matrix (Gu‐DBM) carrier were implanted into a critically sized calvarial defect. The animals were sacrificed at 4 weeks and histomorphometric analysis was then accomplished.Results:TGF‐β1 showed a dose–response relationship, with the higher doses chosen for this study causing more robust osteoinduction.Conclusions:In this pilot dosing study, TGF‐β1 demonstrates increasing osteoinduction with increasing dose levels in this animal model. Laryngoscope, 119:126–130, 2009
Stellate cells in the human child vocal fold macula flava
Authors: Sato Kiminori , Nakashima Tadashi 
Published: January 2009

AbstractObjectives:Vitamin A‐storing vocal fold stellate cells (SCs) in the macula flava (MF) are hypothesized to be involved in the metabolism of extracellular matrices (EM) of the human vocal fold mucosa (VFM). The SCs in the child VFM were examined.Study Design:Histologic analysis of cadaveric human child VFM.Methods:Light and electron microscopic investigations of SCs in the human child VFM were carried out on three excised human child larynges.Results:The SCs were stellate and dense in the child MF. They had cytoplasmic processes, possessed lipid droplets, and stored vitamin A in their cytoplasm. The SCs had a small nucleus‐cytoplasm ratio and rough endoplasmic reticula, suggesting constant protein synthesis in these cells. There were vesicles along the periphery of the cytoplasm, and newly released amorphous materials were seen on the cell surface. There were dense reticular, collagenous, and elastic fibers around SCs. The SCs exhibited strong cytoplasm staining with periodic acid‐Schiff stain and type III collagen. Most of the VFSCs showed CD44 (a cell surface receptor for hyaluronic acid) expression, and a large amount of hyaluronic acid was present immediately adjacent to SCs. This study revealed several morphologic differences between the SCs in the MF and the conventional fibroblasts in the VFM.Conclusions:The SCs in the child MF constantly synthesized EM, essential for viscoelastic properties of the lamina propria of the human VFM, in the stage of vocal fold growth and development. The SCs in the MF were inferred to be involved in the growth and development of human VFM. Laryngoscope, 119:203–210, 2009
Incidence and indications for revision cochlear implant surgery in adults and children
Authors: Brown Kevin D. , Connell Sarah S. , Balkany Thomas J. , Eshraghi Adrien E. , Telischi Fred F. , Angeli Simon A. 
Published: January 2009

AbstractObjectives/Hypothesis:To identify the incidence of and common causes for cochlear implant revision.Study Design:Retrospective case series.Methods:Operative records were reviewed for all cases of revision cochlear implantation from 1992 to 2006. The causes for reimplantation were classified as hard device failure, soft device failure, exposure/infection, receiver/stimulator migration, and electrode migration. Manufacturers' failure analysis of explanted devices was likewise determined.Results:Eight hundred and six cochlear implants were performed during the study period including 44 (5.5%) revision procedures. The revision rate was 7.3% for children and 3.8% for adults and reached statistical significant difference. The most common reasons for revision were device failure (78%; 55% hard failure, 23% soft failure) followed by electrode migration (9%) and receiver/stimulator migration (7%). Manufacturers' analysis of failed devices revealed loss of hermetic seal and cracked cases to be the most common causes of failure. Bench analysis of 5/10 explanted devices that were soft failures demonstrated identifiable device defects.Conclusions:Revision cochlear implant surgery is an infrequent occurrence. Its incidence appears to be higher in children than in adults, although in this series does not appear to be due to increased wound complications, infections, or trauma. Explanted implants that have soft failure as the etiology may have demonstrable defects on bench testing. Laryngoscope, 119:152–157, 2009
Monitoring stress levels in postgraduate medical training
Authors: Hill Justin D. , Smith Richard J. H. 
Published: January 2009

AbstractObjectives:The Accreditation Council for Graduate Medical Education (ACGME) mandates that residency Program Directors (PD) monitor resident well‐being, including stress. Burnout, as a measure of work‐related stress, is defined by a high degree of emotional exhaustion and depersonalization, and a low degree of personal accomplishment using the Maslach Burnout Inventory‐Human Services Survey (MBI‐HSS). The purpose of this study is to describe the use of the MBI‐HSS as a method of monitoring stress levels in an academic otolaryngology residency training program and introduce this survey as a tool for wider use in meeting ACGME requirements.Methods:The MBI‐HSS was administered to residents in an academic otolaryngology residency training program on three separate occasions: at the beginning, middle, and end of different academic years. In addition, at the time of the third administration, the MBI‐HSS was completed by faculty and staff in the same department. Surveys were completed and collected anonymously. Responses were scored against normative data from the MBI‐HSS overall sample and the medicine subscale. Low, average, and high levels of burnout were identified for the individual categories of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA); average levels for each category were calculated.Results:Twenty‐two residents completed the first survey, taken near the end of an academic year; 19 completed the second administration in the middle of the following academic year; and 24 completed the third survey at the beginning of the subsequent academic year. Thirteen faculty and 23 staff also completed the third survey. We found that three, one, and one residents reported high levels of burnout on the first, second, and third surveys, respectively. These figures compare to one faculty member and no staff members in the same department reporting high levels of burnout.Conclusions:The MBI‐HSS is an established and validated tool for identifying burnout in resident physicians. Residency PDs may find the MBI‐HSS useful as an aid in monitoring resident well‐being and stress. In our own department, we found levels of burnout comparable to those previously reported for residents and faculty in this specialty. Laryngoscope, 119:75–78, 2009
An early detection protocol for invasive fungal sinusitis in neutropenic patients successfully reduces extent of disease at presentation and long term morbidity
Authors: DelGaudio John M. , Clemson Lindsey A. 
Published: January 2009

AbstractObjectives:To evaluate a multidisciplinary early intervention protocol for invasive fungal sinusitis (IFS) in neutropenic patients and its effect on degree of tissue involvement at time of presentation and effect on morbidity and mortality.Study Design:Retrospective review.Methods:A chart review was performed for cases of acute fulminant IFS in neutropenic patients at Emory University Hospital from 1995 to 2007. Inclusion required tissue diagnosis of IFS, neutropenia, and adequate records of the following: tissue involvement at presentation, number and extent of surgical procedures performed, morbidity, and mortality. Group 1 included patients prior to 2001, and group 2 included patients after protocol initiation in 2001. The groups were compared for the number of tissue sites involved at presentation, number of surgical procedures performed, long‐term morbidity, and mortality.Results:Twenty‐eight cases of IFS were identified. The average number of sites involved at presentation was 2.5 in group 1 and 1.5 in group 2 (P = .059). The average number of procedures was 2.2 in group 1 and 1.0 in group 2 (P = .026). Long‐term morbidity occurred in 43% (6/14) of group 1 patients compared with 7.1% (1/14) of group 2 patients (P = .029). Mortality from IFS was 7.1% in group1 and 7.1% in group 2.Conclusions:IFS requires early diagnosis and treatment for optimum outcome. A protocol of early intervention for neutropenic patients is effective in early detection of IFS with fewer sites of involvement at diagnosis, fewer surgeries, and less long‐term morbidity. No difference in survival was found, as this is more a factor of the underlying cause of the neutropenia. Laryngoscope, 119:180–183, 2009
Tonsillectomy vs. deep tonsil biopsies in detecting occult tonsil tumors
Authors: Waltonen Joshua D. , Ozer Enver , Schuller David E. , Agrawal Amit 
Published: January 2009

AbstractObjectives:To compare the yield of detecting occult tumors by performing tonsillectomy and deep tonsil biopsies in patients with metastatic carcinoma to the neck in whom a primary tumor was not evident on physical examination, radiography, or panendoscopy.Study Design:Retrospective study.Methods:Over a 10‐year period, the charts of all patients diagnosed with metastatic carcinoma to the neck in whom a primary tumor was not evident on examination, imaging, and panendoscopy were reviewed. Specifically, we compared groups of patients who had undergone diagnostic tonsillectomy with those who had undergone deep tonsil biopsies in search of an occult primary tumor.Results:One hundred twenty‐two patients were identified as meeting study criteria. All underwent directed biopsies of the tongue base, hypopharynx, and nasopharynx as well as either deep tonsil biopsies or diagnostic tonsillectomy. Deep tonsil biopsies were performed in 95 patients. In this group, 11 primary tumors were subsequently identified (11.6%): three in the tonsil, six in the tongue base, one in the hypopharynx, and one in the nasopharynx. Tonsillectomy was performed in 27 patients. Eleven primary tumors were identified (40.7%): eight in the tonsils, two in the tongue base, and one in the hypopharynx. All tonsil primary tumors identified were ipsilateral to the presenting neck mass. The overall yield of finding an occult primary carcinoma in the tonsil was 3.2% for deep tonsil biopsies vs. 29.6% for tonsillectomies (P < .0002).Conclusions:Tonsillectomy offers a significantly higher likelihood of finding occult tonsillar tumors than deep tonsil biopsy. Laryngoscope, 119:102–106, 2009
Evolution of endoscopic surgical therapy for Zenker's diverticulum
Authors: Hillel Alexander T. , Flint Paul W. 
Published: January 2009

AbstractZenker's diverticulum is a rare anatomic defect that physicians have confronted for almost 250 years. Its location at the interface of the pharynx, neck, and mediastinum makes surgical access difficult and risks severe morbidity. Minimally invasive endoscopic surgical repair of Zenker's diverticulum has been attempted for more than a century as an alternative to reduce morbidity of an open transcervical approach. However, limitations due to available antibiotics, instrumentation, and laryngoscopes, as well as a general discomfort with a sutureless closure of the mucosal excision, have delayed widespread adoption of minimally invasive repair until the last 10 to 15 years. This manuscript will detail the historical evolution of endoscopic surgical therapy for Zenker's diverticulum and highlight the work of two otolaryngologists, Chevalier Jackson and Gosta Dohlman, who were critical in advancing the surgical technique and reducing morbidity. Lastly, this manuscript will analyze the delay in widespread application of endoscopic surgical repair of Zenker's diverticulum. Laryngoscope, 119:39–44, 2009
Comparison of three common tonsillectomy techniques: A prospective randomized, double‐blinded clinical study
Authors: Wilson YuShan L. , Merer David M. , Moscatello Augustine L. 
Published: January 2009

AbstractObjective:To evaluate three current tonsillectomy techniques—intracapsular microdebridement, intracapsular coblation, and traditional extracapsular electrocautery dissection—comparing surgical parameters, efficacy, and morbidity in the treatment for obstructive sleep disordered breathing in children.Study Design:Prospective, double‐blinded study with follow‐up by telephone interview.Method:From February 2004 to July 2006, a total of 156 patients between the ages of 6 months and 22 years scheduled for adenotonsillectomy were randomly assigned to electrocautery, coblator, and microdebrider groups.Outcome Measures:1) Patient demographics; 2) Intraoperative time; 3) Surgeon's perception of difficulty; 4) Indicators of postoperative morbidity: pain, use of pain medication, return to diet, and activity level; 5) Complications; 6) Cost.Results:Microdebrider technique produced the shortest total surgical time, averaging 16 minutes. Use of coblation resulted in 2 less days of pain medication compared to electrocautery. Patients in the coblator and microdebrider groups returned to a normal diet 1.51 days and 1.77 days earlier, respectively, than in the electrocautery group. They also returned to preoperative activity levels 1.85 days and 2.06 days earlier than in the electrocautery group. Of all three methods, the microdebrider was the most cost effective. The coblator and microdebrider did not differ significantly from each other in all other parameters. The three techniques showed no statistically significant difference in assessment of difficulty, average pain scores, or postoperative complications.Conclusions:Postoperative recovery following intracapsular adenotonsillectomy in children with obstructive sleep apnea is significantly earlier with use of either the coblator or microdebrider versus traditional extracapsular tonsillectomy with electrocautery. Microdebrider and coblator were comparable in all other areas except for shorter operative time and less cost for the microdebrider. Laryngoscope, 119:162–170, 2009
Subcutaneous implants coated with tissue‐engineered cartilage
Authors: Kim Soo Whan , Dobratz Eric J. , Ballert John A. , Voglewede Andrew T. , Park Stephen S. 
Published: January 2009

AbstractObjective:To investigate the ability to coat two alloplastic implants, porous high‐density polyethylene (PHDPE) and expanded polytetrafluoroethylene (e‐PTFE), with tissue‐engineered cartilage (TEC) from human septal chondrocytes in a mouse model.Study Design:Prospective study.Methods:PHDPE and e‐PTFE disks were coated with alginate impregnated with human septal chondrocytes and implanted into athymic nude mice. A control group consisting of PHDPE and e‐PTFE disks coated with alginate only were implanted. Gross, histological, and biochemical characteristics of the TEC constructs were examined at 10 and 20 weeks following implantation.Results:One animal in the experimental group and one animal in the control group died. Implants coated with TEC were successfully generated in 18 (94.7%) mice in the experimental group (n = 19) and in zero (0%) of the control group (n = 17). The final weight of each harvested specimen decreased in the control group and increased in the experimental group, when compared with preimplant weight. Mean decrease in weight in the control group was greater at 20 weeks than at 10 weeks (P = .017). Mean increase in weight in the experimental group was greater at 20 weeks than at 10 weeks (P = .009). The diameter of the control group decreased, while the diameter of the experimental group was maintained. The reduction in diameter was less in the experimental group than in the control group at 10 (P = .018) and 20 weeks (P = .01). Gross and histological examination confirmed the formation of neocartilage, with characteristics similar to native cartilage, in the experimental group at 10 and 20 weeks. Glycosaminoglycan content in the experimental group at 20 weeks was approximately 80% of that measured in implanted human septal cartilage. Cartilaginous and fibrovascular ingrowth into implant pores was more extensive in the PHDPE than the e‐PTFE experimental group.Conclusions:Implants coated with TEC from human septal cartilage can be reliably produced in the athymic nude mouse model. Maintenance of shape, as measured by the conservation of construct diameter, is possible. Fibrovascular ingrowth and cartilage formation into the pores of the alloplastic implants was observed. This integration of a construct composed of a synthetic implant coated with TEC may improve the performance of alloplastic implants through better long‐term fixation and increased resistance to infection. Laryngoscope, 119:62–66, 2009
Role of vortices in voice production: Normal versus asymmetric tension
Authors: Khosla Sid , Murugappan Shanmugam , Paniello Randal , Ying Jun , Gutmark Ephraim 
Published: January 2009

AbstractObjectives:Decreasing the closing speed of the vocal folds can reduce loudness and energy in the higher frequency harmonics, resulting in reduced voice quality. Our aim was to study the correlation between higher frequencies and the intraglottal vorticity (which contributes to rapid closing by producing transient negative intraglottal pressures).Methods:Using six excised canine larynges (three with symmetric and three with asymmetric, periodic vocal fold motion), intraglottal vorticity was calculated from 2D velocity fields measured using particle imaging velocimetry.Results:There is a strong correlation between intraglottal vorticity and acoustic energy in the higher frequencies; in periodic asymmetric motion, the vorticity and higher frequencies are both reduced.Conclusions:For unilateral vocal fold paralysis, these findings suggest one reason why periodic, asymmetric motion, may produce an abnormal voice. Further study will help determine when and why reinnervation, as opposed to medialization, may result in better voice quality. Laryngoscope, 119:216–221, 2009