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Objective: A deviated nasal septum (DNS) can result in an anatomical obstruction and impact lung function through prolonged suboptimal inspiration. Given the improvements in respiration reported by patients following septoplasty or septorhinoplasty (with or without inferior turbinate reduction), our study investigated the effect of these procedures on pulmonary function through a systematic review and meta‐analysis. Data Sources: Medline, Embase, Cochrane Databases, Web of Science, and Google Scholar. Review Methods: The review was registered with PROSPERO [CRD42022316309]. The study population was composed of adult patients (18–65) who were symptomatic with confirmed DNS. Extracted outcomes (pre‐operative versus postoperative) included the six‐minute walk test (6MWT) and pulmonary function tests (FEV1, FVC, FEV1/FVC, FEF25‐75, PEF). Meta‐analyses were performed using a random‐effects model. Results: Three studies included measures of the 6MWT in meters and all three found a statistically significant increase in the distance walked after surgery with a mean difference of 62.40 m (95% CI 24.79–100.00). Statistically significant improvements in PFT outcomes were observed with a standard mean difference of 0.72 for FEV1 (95% CI 0.31–1.13), 0.63 for FVC (95% CI 0.26–1.00), and 0.64 for PEF (95% CI 0.47–0.82). Of the twelve studies which measured PFT outcomes, six showed statistically significant improvements, three studies showed mixed results, and three studies found no difference in PFT outcomes between pre‐and post‐surgery testing. Conclusions: The present study suggests that pulmonary function does improve after nasal surgery for DNS, but the high heterogeneity observed in the meta‐analyses indicates that the evidence supporting this conclusion is low. Laryngoscope, 133:2837–2845, 2023 [ABSTRACT FROM AUTHOR]

The article in the Laryngoscope journal responds to real-world adverse events following the use of Type 2 biologics in Chronic Rhinosinusitis with Nasal Polyps. It acknowledges a reported case of alopecia areata in patients treated with dupilumab, a known adverse event in atopic dermatitis but not previously reported in CRSwNP. The onset of adverse events like alopecia and arthralgia following biologic use suggests a gradual alteration of the immune response in patients. The study emphasizes the diverse responses to dupilumab in real-world patients with CRSwNP. [Extracted from the article]

Despite the ecological significance of the mutualistic relationship between Symbiodiniaceae and reef‐building corals, the molecular interactions during establishment of this relationship are not well understood. This is particularly true of the transcriptional changes that occur in the symbiont. In the current study, a dual RNA‐sequencing approach was used to better understand transcriptional changes on both sides of the coral–symbiont interaction during the colonization of Acropora tenuis by a compatible Symbiodiniaceae strain (Cladocopium goreaui; ITS2 type C1). Comparison of transcript levels of the in hospite symbiont 3, 12, 48 and 72 hr after exposure to those of the same strain in culture revealed that extensive and generalized down‐regulation of symbiont gene expression occurred during the infection process. Included in this "symbiosis‐derived transcriptional repression" were a range of stress response and immune‐related genes. In contrast, a suite of symbiont genes implicated in metabolism was upregulated in the symbiotic state. The coral data support the hypothesis that immune‐suppression and arrest of phagosome maturation play important roles during the establishment of compatible symbioses, and additionally imply the involvement of some SCRiP family members in the colonization process. Consistent with previous ecological studies, the transcriptomic data suggest that active translocation of metabolites to the host may begin early in the colonization process, and thus that the mutualistic relationship can be established at the larval stage. This dual RNA‐sequencing study provides insights into the transcriptomic remodelling that occurs in C. goreaui during transition to a symbiotic lifestyle and the novel coral genes implicated in symbiosis. [ABSTRACT FROM AUTHOR]

Summary: Reef‐building corals live in a mutualistic relationship with photosynthetic algae (family Symbiodiniaceae) that usually provide most of the energy required by the coral host. This relationship is sensitive to temperature stress; as little as a 1°C increase often leads to the collapse of the association. This sensitivity has led to an interest in the potential of more stress‐tolerant algae to supplement or substitute for the normal Symbiodiniaceae mutualists. In this respect, the apicomplexan‐like microalga Chromera is of particular interest due to its greater temperature tolerance. We generated a de novo transcriptome for a Chromera strain isolated from a GBR coral ('GBR Chromera') and compared with those of the reference strain of Chromera ('Sydney Chromera'), and to those of Symbiodiniaceae (Fugacium kawagutii, Cladocopium goreaui and Breviolum minutum), as well as the apicomplexan parasite, Plasmodium falciparum. In contrast to the high sequence divergence amongst representatives of different genera within the family Symbiodiniaceae, the two Chromera strains featured low sequence divergence at orthologous genes, implying that they are likely to be conspecifics. Although KEGG categories provide few criteria by which true coral mutualists might be identified, they do supply a molecular rationalization that explains the ecological dominance of Cladocopium spp. amongst Indo‐Pacific reef corals. The presence of HSP20 genes may contribute to the high thermal tolerance of Chromera. [ABSTRACT FROM AUTHOR]

Using stem cells to replace the lost beta cells is a hopeful strategy in the treatment of diabetic patients. Furthermore, during stem cell culture and therapy, it is a need to use a substrate to act as a supportive matrix to mimic 3D in vivo microenvironment. Therefore, in this study, human adipose‐derived stem cells were used to differentiate into insulin‐producing cells (IPCs) on a silk/polyethersulfone (PES) scaffold. After exposing to the differentiation media, 2D and 3D (silk/PES) cultured cells were gradually aggregated and formed spherical shaped clusters. The viability of cells was comparable in both 3D and 2D culture. As the results of gene expression assay in both RNA and protein level showed, the differentiation efficiency was higher in 3D culture. Furthermore, ELISA revealed that the release of C‐peptide and insulin was higher in 3D than 2D culture. It seems that silk/PES nanofibrous hybrid scaffold could provide an appropriate matrix to mimic in vivo microenvironment and therefore increases the IPC differentiation potency of stem cells. [ABSTRACT FROM AUTHOR]

Objectives: The congenital lung malformation volume ratio (CVR) is a prenatal ultrasound measurement that parameterizes congenital lung malformation (CLM) size. The aims of this study were to use serial measurements to create estimated growth curves of fetal CVR for asymptomatic and symptomatic neonates with CLM and to investigate whether a discriminant prognostic model based on these measurements could predict accurately which fetuses with CLM will require invasive respiratory support at delivery and should therefore be delivered at a tertiary-care facility.Methods: This was a retrospective study of fetuses diagnosed prenatally with CLM at three tertiary-care children's hospitals between 2009 and 2016. Those with two or more sonographic measurements of CVR were included. Serial fetal CVR measurements were used to create estimated growth curves for neonates with and those without respiratory symptoms at delivery, defined as requiring invasive respiratory support for the first 24 h after delivery. A discriminant model based on serial CVR measurements was used to calculate the dynamic probability of the need for invasive respiratory support. The performance of this model overall and in preterm and term neonates was compared with those using maximum CVR thresholds of 1.0 and 1.6.Results: Of the 147 neonates meeting the inclusion criteria, 16 (10.9%) required postnatal invasive respiratory support. The estimated CVR growth curve models showed different growth trajectories for asymptomatic and symptomatic neonates, with significantly higher CVR in symptomatic neonates, and values peaking late in the second trimester at around 25 weeks' gestation in asymptomatic neonates. All prognostic methods had high accuracy for the prediction of the need for invasive respiratory support in term neonates, but the discriminant model had the best performance overall (area under the receiver-operating characteristics curve (AUC) = 0.88) and in the preterm population (AUC = 0.85).Conclusions: The estimated CVR growth curves showed different growth patterns in asymptomatic and symptomatic neonates with CLM. The dynamic discriminant model performed well overall and particularly in neonates that were carried to term. Development of an externally validated clinical tool based on this analysis could be useful in determining the site of delivery for fetuses with CLM. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

In developing countries, governments often lack the authority and resources to implement conservation outside of protected areas. In such situations, the integration of conservation with local livelihoods is crucial to species recovery and reintroduction efforts. The hirola Beatragus hunteri is the world's most endangered antelope, with a population of <500 individuals that is restricted to <5% of its historical geographic range on the Kenya–Somali border. Long‐term hirola declines have been attributed to a combination of disease and rangeland degradation. Tree encroachment—driven by some combination of extirpation of elephants, overgrazing by livestock, and perhaps fire suppression—is at least partly responsible for habitat loss and the decline of contemporary populations. Through interviews in local communities across the hirola's current range, we identified socially acceptable strategies for habitat restoration and hirola recovery. We used classification and regression trees, conditional inference trees, and generalized linear models to identify sociodemographic predictors of support for range‐restoration strategies. Locals supported efforts to conserve elephants (which kill trees and thus facilitate grass growth), seed and fertilize grass, and remove trees, but were opposed to livestock reduction. Locals were ambivalent toward controlled burns and soil ripping (a practice through which soil is broken up to prevent compaction). Livestock ownership and years of residency were key predictors of locals' perceptions toward rangeland‐restoration practices. Locals owning few livestock were more supportive of elephant conservation, and seeding and fertilization of grass, while longer term residents were more supportive of livestock reduction but were less supportive of elephant conservation. Ultimately, wildlife conservation outside protected areas requires long‐term, community‐based efforts that are compatible with human livelihoods. We recommend elephant conservation, grass seeding and fertilization, manual tree removal and resting range from livestock both to enhance the potential for hirola recovery and to build positive rapport with local communities in the geographic range of this critically endangered species. The hirola Beatragus hunteri is the world's most endangered antelope, with the population of less than 500 individuals restricted to less than 5% of its historical geographic range on the Kenya–Somali border. Long‐term hirola declines have been attributed to a combination of disease and rangeland degradation. Through interviews with local communities across the hirola's current range, we identified socially acceptable strategies for habitat restoration and hirola recovery. We recommend elephant conservation, grass seeding and fertilization, manual tree removal and resting range from livestock (i.e. restricting livestock grazing in certain areas) both to enhance the potential for hirola recovery and to build positive rapport with the local communities in the geographic range of this critically endangered species. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To assess staffing levels of healthcare professionals involved in the care of children and young people with diabetes in the UK. Methods: A web‐based questionnaire was distributed to lead consultant paediatricians from all paediatric diabetes services in the UK between October and December 2014. Data on staffing levels and other aspects of diabetes services were collected and differences between the four nations of the UK and across the 10 English diabetes networks were explored. Results: Some 175 services (93%) caring for 29 711 children and young people aged ≤ 24 years with diabetes participated in the survey. Northern Ireland and Wales had the lowest ratio of total staff to patient population. Nursing caseloads per one whole‐time equivalent (WTE) nurse ranged from 71 patients in England to 110 patients in Northern Ireland with only 52% of the UK services meeting the Royal College of Nursing recommended nurse‐to‐patient ratio of > 1 : 70. Scotland and Northern Ireland had the highest ratio of consultants and fully trained doctors per 1000 patients (3.5 WTE). Overall, 17% of consultants had a Certificate of Completion of Training in Endocrinology and Diabetes. Some 44% of dietitians were able to adjust insulin dose. Only 43% of services provided 24‐h access to advice from the diabetes team and 82% of services had access to a psychologist. Staffing levels adjusted for volume were not directly related to glycaemic performance of services in England and Wales. Conclusions: Wide variations in staffing levels existed across the four nations of the UK and important gaps were present in key areas. [ABSTRACT FROM AUTHOR]

Aim To understand the scope for improving children's glycaemic outcomes by reducing variation between clinics and examine the role of insulin regimen and clinic characteristics. Methods Cross-sectional analysis of 2012-2013 National Paediatric Diabetes Audit data from 21 773 children aged < 19 years with Type 1 diabetes cared for at 176 clinics organized into 11 regional diabetes networks in England and Wales. Variation in HbA1c was explored by multilevel models with a random effect for clinic. The impact of clinic context was quantified by computing the per cent of total variation in HbA1c which occurs between clinics (intraclass correlation coefficient; ICC). Results Overall, 69 of the 176 diabetes clinics (39%) had a glycaemic performance that differed significantly from the national average after adjusting for patient case-mix with respect to age, gender, diabetes duration, deprivation and ethnicity. However, differences between clinics accounted for 4.7% of the total variation in HbA1c. Inclusion of within-clinic HbA1c standard deviation led to a substantial reduction in ICC to 2.4%. Insulin regimen, clinic volume and diabetes networks had a small or moderate impact on ICC. Conclusions Differences between diabetes clinics accounted for only a small portion of the total variation in glycaemic control because most of the variation was within clinics. This implies that national glycaemic improvements might best be achieved not only by targeting poor centres but also by shifting the whole distribution of clinics to higher levels of quality. [ABSTRACT FROM AUTHOR]

Background The impact of ethnicity and socio-economic status ( SES) on glycaemic control during childhood Type 1 diabetes is poorly understood in England and Wales. Methods We studied 18 478 children with Type 1 diabetes (< 19 years) attending diabetes clinics and included in the 2012-2013 National Paediatric Diabetes Audit. Self-identified ethnicity was categorized as white, Asian, black, mixed, other and 'not-stated' (did not to divulge ethnicity). A small area measure of SES was estimated from the Index of Multiple Deprivation. Multiple linear regression was used to assess associations between ethnicity, SES and glycaemic control (mean HbA1c levels) accounting for age, gender and diabetes duration. The impact of insulin pump use on the ethnicity/ SES-HbA1c associations was tested in 13 962 children. Results All children from minority ethnic groups had higher mean HbA1c compared with white children, with largest differences observed in black and mixed ethnicities [8 mmol/mol (2.9%), 95% CI 5-11 and 7 mmol/mol (2.8%), 95% CI 5-9, respectively]. Lower SES was associated with higher mean HbA1c with a dose effect. The lowest SES group had a mean HbA1c that was 7 mmol/mol (2.8%) (95% CI 6-8) higher compared with the highest SES group, adjusted for ethnicity. Estimates for ethnicity were attenuated, but significant on adjustment for SES. Fewer non-white (white 20.3 vs. black 5.5%) and deprived (least deprived 21.1 vs. most deprived 13.2%) children were on insulin pump therapy. Ethnicity and SES remained significant predictors of HbA1c after accounting for insulin pump use. Conclusion The association between ethnicity and glycaemic control persists after adjustment for deprivation and pump use. An alternative approach to intensive insulin therapy might benefit these vulnerable children. [ABSTRACT FROM AUTHOR]

Aim To assess the prospective association between objectively measured physical activity and kidney function over 4 years in people with Type 2 diabetes. Methods Individuals (120 women and 206 men) participating in the ADDITION-Plus trial underwent assessment of sedentary time ( SED-time), time spent in moderate-to-vigorous-intensity physical activity ( MVPA) and total physical activity energy expenditure ( PAEE) using a combined heart rate and movement sensor, and kidney function [estimated glomerular filtration rate ( eGFR), serum creatinine and urine albumin-to-creatinine ratio ( ACR)] at baseline and after 4 years of follow-up. Multivariate regression was used to quantify the association between change in SED-time, MVPA and PAEE and kidney measures at four-year follow-up, adjusting for change in current smoking status, waist circumference, HbA1c, systolic blood pressure, triglycerides and medication usage. Results Over 4 years, there was a decline in eGFR values from 87.3 to 81.7 ml/min/1.73m2 ( P < 0.001); the prevalence of reduced eGFR ( eGFR < 60 ml/min/1.73m2) increased from 6.1 to 13.2% ( P < 0.001). There were small increases in serum creatinine (median: 81-84 μmol/l, P < 0.001) and urine ACR (median: 0.9-1.0 mg/mmol, P = 0.005). Increases in SED-time were associated with increases in serum creatinine after adjustment for MVPA and cardiovascular risk factors (β = 0.013, 95% CI: 0.001, 0.03). Conversely, increases in PAEE were associated with reductions in serum creatinine (β = -0.001, 95% CI: -0.003, -0.0001). Conclusion Reducing time spent sedentary and increasing overall physical activity may offer intervention opportunities to improve kidney function among individuals with diabetes. (Trial Registry no. ISRCTN 99175498) [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses, associated with reduced health-related quality of life and increased utilization of healthcare services. Chronic upper and lower respiratory diseases often coexist, although the extent to which CRS is associated with developing asthma remains unclear. To investigate the effect of CRS on receiving a subsequent diagnosis of asthma, we used data from a previously conducted national, longitudinal survey.Methods: Respondents from the Canadian National Population Health Survey from 1998/1999 to 2010/2011 were used. Data were analyzed from 11,555 (66.9%) subjects, ≥ 19 years of age and reporting no asthma at baseline. Respondents were reviewed for 12 years to determine the cumulative incidence of asthma. Logistic regression was used to estimate the effect of CRS on the development of asthma, adjusting for age, gender, body mass index, cigarette smoking, and food- or nonfood-related allergies.Results: During the 12-year study period, 6.0% (95% confidence interval [CI] [95% CI]: 5.4%-6.7%) of respondents developed asthma. Baseline CRS (odds ratio [OR]: 2.7, 95% CI: 1.9-3.9), female gender (OR: 1.4, 95% CI: 1.1-1.8), and allergies (OR: 2.6, 95% CI: 2.1 - 3.3) were significantly associated with developing asthma. After adjustment, respondents with CRS were significantly more likely to develop asthma than non-CRS counterparts (OR: 2.0, 95% CI: 1.4-2.9).Conclusion: Results indicate that one in 13 individuals with CRS will be subsequently diagnosed with asthma. Given the economic burden and use of healthcare services associated with asthma, providers managing CRS may consider increased awareness and subsequent treatment for asthma.Level Of Evidence: 4. Laryngoscope, 126:1296-1302, 2016. [ABSTRACT FROM AUTHOR]

Objective This study introduces a novel method, referred to as SeqFF, for estimating the fetal DNA fraction in the plasma of pregnant women and to infer the underlying mechanism that allows for such statistical modeling. Methods Autosomal regional read counts from whole-genome massively parallel single-end sequencing of circulating cell-free DNA (ccfDNA) from the plasma of 25 312 pregnant women were used to train a multivariate model. The pretrained model was then applied to 505 pregnant samples to assess the performance of SeqFF against known methodologies for fetal DNA fraction calculations. Results Pearson's correlation between chromosome Y and SeqFF for pregnancies with male fetuses from two independent cohorts ranged from 0.932 to 0.938. Comparison between a single-nucleotide polymorphism-based approach and SeqFF yielded a Pearson's correlation of 0.921. Paired-end sequencing suggests that shorter ccfDNA, that is, less than 150 bp in length, is nonuniformly distributed across the genome. Regions exhibiting an increased proportion of short ccfDNA, which are more likely of fetal origin, tend to provide more information in the SeqFF calculations. Conclusion SeqFF is a robust and direct method to determine fetal DNA fraction. Furthermore, the method is applicable to both male and female pregnancies and can greatly improve the accuracy of noninvasive prenatal testing for fetal copy number variation. © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Whole-genome sequencing of circulating cell free (ccf) DNA from maternal plasma has enabled noninvasive prenatal testing for common autosomal aneuploidies. The purpose of this study was to extend the detection to include common sex chromosome aneuploidies (SCAs): [47,XXX], [45,X], [47,XXY], and [47,XYY] syndromes. Method Massively parallel sequencing was performed on ccf DNA isolated from the plasma of 1564 pregnant women with known fetal karyotype. A classification algorithm for SCA detection was constructed and trained on this cohort. Another study of 411 maternal samples from women with blinded-to-laboratory fetal karyotypes was then performed to determine the accuracy of the classification algorithm. Results In the training cohort, the new algorithm had a detection rate (DR) of 100% (95%CI: 82.3%, 100%), a false positive rate (FPR) of 0.1% (95%CI: 0%, 0.3%), and nonreportable rate of 6% (95%CI: 4.9%, 7.4%) for SCA determination. The blinded validation yielded similar results: DR of 96.2% (95%CI: 78.4%, 99.8%), FPR of 0.3% (95%CI: 0%, 1.8%), and nonreportable rate of 5% (95%CI: 3.2%, 7.7%) for SCA determination Conclusion Noninvasive prenatal identification of the most common sex chromosome aneuploidies is possible using ccf DNA and massively parallel sequencing with a high DR and a low FPR. © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims We prospectively evaluated the effect of insulin intensification on glycaemic control and lipid levels in children and young persons with Type 1 diabetes in relation to ethnicity. Methods In the first 2 years of a 3-year observation period, as part of routine clinical care, 231 children and young persons (40% white, 28% South Asian, 32% black) from a single clinic were offered intensive insulin therapy. After 2 years, 222 were on intensive therapy and their data were compared between ethnic groups at the end of year 3. Results We observed ethnic differences in HbA1c levels during the study [study beginning and end: white children and young persons 77 and 70 mmol/mol (9.2 and 8.6%) vs. South Asian 72 and 68 mmol/mol (8.7 and 8.4%) vs. black 83 and 79 mmol/mol (9.7 and 9.4%), P-value for ANCOVA = 0.007]. By study end, South Asians had the lowest HDL cholesterol (2.0 vs. 1.4 vs. 1.6 mmol/l, P-value = 0.03) and highest triglyceride levels (0.9 vs. 1.8 vs. 1.0 mmol/l, P-value = 0.001). In linear mixed modelling, after adjustment for socio-economic deprivation and other covariates: (1) black ethnicity was associated with poorer glycaemic control ( P < 0.001) and (2) South Asian ethnicity was associated with higher triglyceride levels ( P < 0.001), independent of HbA1c. Conclusions The effect of insulin intensification on glycaemic control and lipid profile in children and young persons with Type 1 diabetes differs in relation to ethnic group. [ABSTRACT FROM AUTHOR]

The article compares the reverse Trendelenburg position (RTP) and horizontal position performed during functional endoscopic sinus surgery (FESS) of chronic rhinosinusitis (CRS) for the reduction of blood loss. It reports that the FESS performed in the horizontal position allows for consistent orientation of the sinus anatomy and RTP reduces venous return and cardiac output by retaining blood in the lower body parts. The article concludes that RTP improves surgical field and reduces blood loss.

Aims To examine the relationship between social deprivation, intensification of insulin therapy (⩾ three injections per day) and diabetes control in children and adolescents. Methods We performed a longitudinal observational study of 283 children and adolescents with Type 1 diabetes from three UK paediatric centres from 2005 to 2007. We used linear mixed modelling to identify the contribution of the Index of Multiple Deprivation 2004, insulin regimen and demographic factors in explaining longitudinal differences in HbA1c levels. Results Overall mean HbA1c levels were 8.9% [SD 1.4, 74 mmol/ mol (8 mmol / mol)]. Prescribing of intensive therapy increased from 49.2 to 70.1% (X2 = 32.9, P < 0.001), but there was no corresponding improvement in HbA1c levels. Those from more educationally deprived backgrounds were less likely to be started on intensive therapy (P = 0.04). In linear mixed modelling, factors independently associated with poor metabolic control were greater social deprivation (P = 0.01), particularly lower educational levels (P = 0.006), and non-White ethnicity (P = 0.04). Nested terms analysis showed that increased deprivation interacted with non-White ethnicity (P = 0.009) and with intensive insulin therapy (P = 0.03) to result in poorer metabolic control. In a subgroup intensified from conventional regimens during follow-up (n = 75), greater social deprivation was associated with least success of intensive therapy (P = 0.02). Conclusions Social deprivation was associated with low uptake and poor success of insulin intensification and this appeared to be largely mediated via lower educational levels. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The Messerklinger technique is an endoscopic approach to sinus surgery designed to be minimally invasive and preserve mucosa and therefore physiological function. More recently there have been advocates for more radical endoscopic approaches to the frontal sinus such as the modified Lothrop procedure. This study aims to determine the effectiveness of endoscopic frontal sinusotomy in preventing recurrent frontal sinus disease and the need for any revision frontal sinus surgery. Study Design: Retrospective data review. Methods: A retrospective review of the chronic rhinosinusitis database at St. Paul's Sinus Centre was performed, randomly selecting 200 patients who had undergone primary bilateral functional endoscopic sinus surgery between 2000 and 2009. Any endoscopic or radiological recurrences listed on the database were counted along with the number of cases returned to theater for revision surgery. The preoperative Lund-Mackay score was also extracted from the database. Results: In the 200 patients who had undergone their primary surgery at St. Paul's Hospital, the recurrence rate of frontal sinus disease was 19%, with less than one half (8%) requiring revision surgery. The Lund-Mackay scores showed no correlation between disease severity and the incidence of recurrence (P = .35), and there was no difference between polyp and nonpolyp forms of chronic rhinosinusitis (P = .14). A comparison with 100 patients in the database who had received their primary surgery at another center showed that the revision patients had a recurrence rate of 34% and a revision rate of 21%. The patients who did not receive surgical revision were treated satisfactorily with topical medications in the outpatient clinic. Conclusions: Meticulously performed endoscopic frontal sinusotomy with computer guidance appears to be an effective minimally invasive procedure to treat chronic frontal sinusitis secondary to outflow tract obstruction. Properly performed, it is effective in dealing with the most diseased frontal sinus. It offers clear advantages in reducing complications and recurrence rates in frontal sinus disease even in revision cases. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Objective To determine the effect of coeliac disease and treatment with a gluten-free diet on growth and glycaemic control in asymptomatic children with Type 1 diabetes. Methods Data were compared in children with coeliac disease diagnosed by annual antibody screening and jejunal biopsy and treated with a gluten-free diet ( n = 49) against individuals who were antibody negative ( n = 49) matched for age, sex and duration of diabetes. Results No differences in growth were observed. In the years prior to diagnosis of coeliac disease, mean glycated haemoglobin (HbA1c) was lower in cases compared with control subjects [8.3 ± 1.1% vs. 8.7 ± 0.9%, P = 0.02 (mean ± sd)]. In cases, HbA1c deteriorated 12 months from the start of a gluten-free diet to levels similar to control subjects (8.9 ± 1.5% vs. 8.8 ± 1.5%, P-value for analysis of variance = 0.9). In regression analysis, the diagnosis of coeliac disease and start of a gluten-free diet was associated with a rise in HbA1c in the first year of treatment [odds ratio 1.56 (95% confidence intervals 1.16–2.10), P = 0.003] after adjusting for insulin dose and regimen and other variables. Conclusions In children with Type 1 diabetes, lower HbA1c prior to diagnosis of silent coeliac disease rises following treatment with a gluten-free diet to levels similar to those without coeliac disease. Although unproven, these observations may relate to abnormalities at the small bowel mucosa before the appearance of circulating coeliac antibodies. [ABSTRACT FROM AUTHOR]

Objective: To ascertain that antibiotics have no role in the management of bronchiolitis. Design: Multicentre randomized control trial (RCT). Setting: Five purposively selected teaching hospitals in Bangladesh. Patient: Children under 24 months old with bronchiolitis. Interventions: Children were randomized into three groups of therapeutic interventions: parenteral ampicillin (P-Ab), oral erythromycin (O-Ab) and no antibiotic (N-Ab) in adjunct to supportive measures. Main outcome measures: Clinical improvement was assessed using 18 symptoms/signs which were graded on a two-point recovery scale of ‘rapid’ and ‘gradual’, indicating improvement within ‘four days’ and ‘beyond four days’, respectively. Results: Each intervention group consisted of 98 ± 1 children having comparable clinico-epidemiological characteristics at the baseline. The trial revealed that most chesty features (features appearing to arise from chest, i.e. cough, breathing difficulty, wheeze, chest indrawing, tachypnoea, tachycardia, rhonchi and crepitation) demonstrated a gradual recovery, beyond 4th admission day and, not differing among the three intervention groups (p > 0.23, p < 0.62, p = 0.54, p < 0.27, p = 0.75, p = 0.76, p = 0.81, p > 0.98, respectively). Most non-chesty features (features appearing to arise away from chest, i.e. feeding/sleeping difficulties, social smile, restlessness, inconsolable crying, nasal flaring, fever and hypoxaemia) demonstrated a rapid recovery, within 4 days, remaining comparable among the three intervention groups (p < 0.07, p = 0.65, p = 0.24, p < 0.61, p = 0.22, p = 0.84, p = 0.29 and p = 0.96, respectively). However, nasal symptoms (runny nose and nasal blockage) also showed no difference among groups (p = 0.36 and p = 0.66, respectively). Thus, the dynamics of clinical outcome obviates that children not receiving antibiotics had similar clinical outcome than those who did. Conclusion: In hospital settings, managing bronchiolitis with only supportive measures but without antibiotics remains preferable. [ABSTRACT FROM AUTHOR]

Objectives The presence of an ectopic posterior pituitary gland (EPP) in childhood is associated with isolated GH deficiency (IGHD) and multiple pituitary hormone deficiency. GHD in late adolescence has been defined as a peak GH level <5 μg/l. The aim of this study was to identify the likelihood of persistent GHD in late adolescence in patients with an EPP compared with those with a normally sited posterior pituitary (NPP). Methods In 18 patients with an EPP and 15 patients with an NPP, clinical, biochemical and radiographic data were collected. Results In the EPP vs. the NPP group, the change in peak GH levels at the end of growth was less (+0·4[95% confidence interval (CI) - 0·8 to 2·7] vs. +4·1[95%CI + 0·4 to +10·5] μg/l, P-value forancova = 0·03, after adjustment for age and sex). Using a peak GH level of <5 μg/l as a cut-off for GHD, 66% of EPP subjects compared with 40% of NPP subjects had GHD ( P = 0·3). Hundred per cent of EPP subjects had a peak GH level on retesting <10 μg/l, compared with 40% of NPP subjects ( P < 0·001). Conclusion It is important to document GH status at the end of growth, even if there is a structural abnormality of the hypothalamic–pituitary axis. The presence of an EPP compared to an NPP increases the likelihood of persistent GHD by 26%. As all EPP patients had a peak GH level of <10 μg/l, the cut-off for persistent GHD in late adolescence may need to be revised. [ABSTRACT FROM AUTHOR]

Introduction The presence of an ectopic posterior pituitary gland (EPP) on magnetic resonance imaging (MRI) is associated with hypopituitarism with one or more hormone deficiencies. We aimed to identify risk factors for having multiple pituitary hormone deficiency (MPHD) compared to isolated growth hormone deficiency (IGHD) in patients with an EPP. Methods In 67 patients (45 male) with an EPP on MRI, the site (hypothalamic vs. stalk) and surface area (SA) [ × (maximum diameter/2) × (maximum height/2), mm2] of the EPP were recorded and compared in patients with IGHD and MPHD in relation to clinical characteristics. Results In MPHD ( n = 32) compared to IGHD ( n = 35) patients: age of presentation was younger (1·4 [0·1–10·7] vs. 4·0 [0·1–11·3] years, P = 0·005), major incidents during pregnancy were increased (47% vs. 20%, P = 0·02) as were admissions to a neonatal intensive care unit (NICU) (60% vs. 26%, P = 0·04), whilst EPP SA was lower (12·3 [2·4–34·6] vs. 25·7 [6·9–48·2] mm2, P < 0·001). In patients with a hypothalamic ( n = 56) compared to a stalk sited EPP ( n = 11): prevalence of MPHD was greater (55% vs. 9%, P = 0·05) and EPP surface area was smaller (17·3 [2·4–48·2] vs. 25·3 [11·8–38·5] mm2, P < 0·001). In regression analysis, after adjusting for age, presence of MPHD was associated with: major incidents during pregnancy (RR 6·8 [95%CI 1·2–37·7]), hypothalamic EPP site (RR 10·9 [1·0–123·9]) and small EPP SA (RR 2·5 [1·0–5·0] for tertiles of SA). Conclusion In patients with an EPP, adverse antenatal events, size (small) and position (hypothalamic) of the posterior pituitary gland on MRI were associated with MPHD. These findings suggest that adverse factors during pregnancy may be important for the development of an EPP. [ABSTRACT FROM AUTHOR]

Iron storage disease (haemochromatosis) is thought to be the cause of many disorders unique to captive black rhinoceroses (Diceros bicornis). To establish reliable reference ranges for iron parameters, serum samples from 27 eastern black rhinoceroses (Diceros bicornis michaeli) from a translocation programme in Kenya were analysed and compared with the samples from 17 captive individuals. The transferrin saturation, serum iron concentration and gamma glutamyl transferase were significantly higher in the captive rhinoceroses, but these elevations were not evident when the results were compared with previously published data. [ABSTRACT FROM AUTHOR]

Abstract Background Different time-concentration profiles of plasma insulin following insulin modification of a frequently sampled intravenous glucose-tolerance-test (FSIVGTT) were observed in a study investigating maternal metabolism and fetal macrosomia. We aimed to investigate whether these differences were related to the volume of distribution of insulin, insulin clearance, or both. Design Forty-four women were studied between 33 and 35 weeks’ gestation using an insulin-modified FSIVGTT. Specific insulin was assayed with an enzyme-linked immunosorbent assay. Insulin sensitivity was calculated using the minimal model and the homeostasis model assessment (HOMA). The volume of distribution and clearance of insulin were calculated from measurements between 2 and 155 min after insulin modification using a one-compartment model. Results In accordance with the method for deriving the volume of distribution, there was a significant negative correlation between the increment in insulin concentration and the volume of distribution (rho = -0·92, P < 0·0001). The insulin increment was also related negatively to the clearance of insulin (rho = -0·88, P < 0·0001). There was a significant correlation between the volume of distribution and both the insulin sensitivity index (rho = 0·56, P < 0·0001) and HOMA-%S (rho = 0·30, P = 0·048), and between the clearance of insulin and both the insulin sensitivity index (rho = 0·83, P < 0·0001)) and HOMA-%S (rho = 0·34, P = 0·025). Conclusion The different time-concentration profiles of plasma insulin resulted from differences in the volume of distribution and clearance of insulin. There was a correlation between insulin kinetics and the insulin sensitivity index. Further research is required to investigate possible mechanisms by which insulin kinetics may be related to insulin sensitivity. [ABSTRACT FROM AUTHOR]

MK‐4076 or sodium 1‐(1(R)‐(3‐(2‐(7‐chloro‐2‐quinolinyl)‐(E)‐ ethenyl)phenyl) 3‐(1‐hydroxy‐1‐methylethyl)phenyl)propyl)thio)methyl) cycloproprane) acetate is a novel, potent, and specific LTD4‐receptor antagonist. The safety, tolerability and plasma drug profiles of single oral doses of MK‐0476 (capsules) were evaluated in 18 healthy male volunteers assigned to one of the two parallel 9‐subject panels. Under fasting conditions, increasing single doses of 20 to 800 mg were administered in a first part of the study and in a second part, 200 mg MK‐0476 was given either as a solution, under fasting conditions, or as capsules, after a standard breakfast. All volunteers completed the study. Side effects, reported by the investigator to be related to study drug, were mild and transient. No laboratory abnormalities were noted. In the evaluated dose range of MK‐0476 (20 to 800 mg) the median value of tmax ranged from 2 to 4 h, while the apparent t1/2 value averaged 4 to 5 h. The median tmax value of the 200 mg capsule dose was not significantly different from the median tmax of the 200 mg oral solution dose indicating that neither disintegration nor dissolution is a rate‐limiting step for the absorption of MK‐0476 from capsules. There was a statistically significant increase in the AUC (geometric mean ratio of fed/fast was 2.52 with 95% confidence interval of 1.25, 5.06) and in Cmax (geometric mean ratio of fed/fast was 1.36 with 95% confidence interval of 0.60, 3.04) when MK‐0476 was given together with a breakfast, suggesting an increase in bioavailability.(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]

Neurological and psychiatric symptoms are common presentations, but are often ignored in fresh salted gray Mullet fish intoxication. We report 2 patients with chronic renal failure at a predialyzed stage who developed refractory status epilepticus after ingestion of putrid salted gray Mullet. We warn consultant neurologists that fresh salted gray Mullet fish intoxication must be considered when patients with chronic kidney disease present with seizures or other unexplained neurological or psychiatric symptoms. [ABSTRACT FROM AUTHOR]

Objective: 1) To determine the effectiveness of triamcinolone‐soaked middle‐meatal‐spacers (MMS) within a perforated surgical gloved finger on improving healing and reducing inflammation in CRS patients post‐FESS. 2) To determine if triamcinolone‐soaked MMS within a perforated surgical gloved finger improves patient reported outcomes post‐FESS. Methods: Double‐blind randomized controlled trial of 50 CRS patients undergoing FESS. Patients receive MMS in perforated glove fingers bilaterally, impregnated with triamcinolone (experimental arm) or saline (control). Primary outcome measure is the validated Philpott‐Javer endoscopic mucosal inflammation scoring system at postoperative days 14, 28, and 3, 6 months. SNOT‐22 scores were secondary outcomes. Results: Our interim results, based on 36 participants, are optimistic. Patients in the triamcinolone group show clinically significant improvement in Philpott‐Javer endoscopic scores compared to saline controls at 28 days postoperative examination, however this difference was not currently statistically significant (1.185 vs 2.65; P =. 084). There was no significant difference between SNOT‐22 scores for the 2 groups at postoperative day 28 (P =. 88). Conclusion: Triamcinolone‐impregnated MMS may improve postoperative inflammation and healing in CRS patients following FESS. [ABSTRACT FROM AUTHOR]

Objectives: (1) Investigate the ability of a sinus‐specific health‐related quality of life questionnaire (HRQoL) to distinguish clinically significant chronic rhinosinusitis (CRS) among adults with cystic fibrosis (CF). (2) Determine an appropriate cutoff score on the Sinonasal Outcomes Test‐22 (SNOT‐22) with sufficient test sensitivity and specificity, to assist caregivers in identifying adults with CF who may warrant specialist referral and treatment. Methods: Participants were enrolled at an adult‐specific CF clinic in a tertiary academic hospital in Vancouver, Canada. Subjects completed the SNOT‐22 followed by endoscopic assessment by otolaryngologists. The Canadian Clinical Practice Guidelines for Chronic Rhinosinusitis were used to confirm diagnosis of CRS. Results: To date, 52 of 80 individuals with a confirmed diagnosis of CF have participated in this study. Thirty‐nine (75.0%) individuals were identified with CRS, 12 (30.8%) of whom presented with nasal polyposis. Aggregate SNOT‐22 scores were significantly higher among individuals with CRS compared to non‐CRS counterparts (39.4 ± 20.0 vs 22.7 ± 8.7, P =. 007, 95% confidence interval [CI] for mean difference: 4.7, 28.7). A SNOT‐22 score >26 was found to have a test sensitivity of 74.4% and specificity of 66.7% for diagnosis of CRS (AUC = 0.77, P <. 01). Using SNOT‐22 scores related to rhinological symptoms increased the likelihood ratio of a positive test when compared to aggregate scores (8.3 vs 2.2, respectively). Conclusions: The SNOT‐22 significantly discriminates between CF adults with and CF adults without CRS. Using rhinological symptom scores increases the likelihood of detecting true CRS cases. The use of this questionnaire may assist specialists in identifying individuals who have clinically significant CRS, warranting specialist referral and treatment. [ABSTRACT FROM AUTHOR]