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Anaerobic digestion treatments have often been used for biological stabilization of solid wastes. These treatment processes generate biogas which can be used as a renewable energy sources. Recently, anaerobic digestion of solid wastes has attracted more interest because of current environmental problems, most especially those concerned with global warming. Thus, laboratory-scale research on this area has increased significantly. In this review paper, the summary of the most recent research activities covering production of biogas from solid wastes according to its origin via various anaerobic technologies was presented.

Objective: To validate the VOXEL-MAN TempoSurg simulator for temporal bone dissection., Study Design: Prospective international study., Setting: Otolaryngology departments of 2 academic health care institutions in the United Kingdom and United States., Subjects and Methods: Eighty-five subjects were recruited consisting of an experienced and referent group. Participants performed a standardized familiarization session and temporal bone dissection task. Realism, training effectiveness, and global impressions were evaluated across 21 domains using a 5-point Likert-type scale. A score of 4 was the minimum threshold for acceptability., Results: The experienced group comprised 25 otolaryngology trainers who had performed 150 mastoid operations. The referent group comprised 60 trainees (mean otolaryngology experience of 2.9 years). Familiarization took longer in the experienced group (P = .01). User-friendliness was positively rated (mean score 4.1). Seventy percent of participants rated anatomical appearance as acceptable. Trainers rated drill ergonomics worse than did trainees (P = .01). Simulation temporal bone training scored highly (mean score 4.3). Surgical anatomy, drill navigation, and hand-eye coordination accounted for this. Trainees were more likely to recommend temporal bone simulation to a colleague than were trainers (P = .01). Transferability of skills to the operating room was undecided (mean score 3.5)., Conclusion: Realism of the VOXEL-MAN virtual reality temporal bone simulator is suboptimal in its current version. Nonetheless, it represents a useful adjunct to existing training methods and is particularly beneficial for novice surgeons before performing cadaveric temporal bone dissection. Improvements in realism, specifically drill ergonomics and visual-spatial perception during deeper temporal bone dissection, are warranted.

Objectives/hypothesis: Previous studies have identified a predominant learning style in trainees from different specialties, more recently in otolaryngology residents. The purpose of our study was to determine a predominant learning style within otolaryngology fellowships and to identify any differences between otolaryngology fellows and residents., Study Design: We conducted a survey of otolaryngology fellows at 25 otolaryngology fellowship programs accredited by the Accreditation Council for Graduate Medical Education., Methods: We emailed Kolb's Learning Style Index version 3.1 to 16 pediatric otolaryngology (PO) and 24 otology/neurotology (ON) fellows. This index is a widely used 12-item questionnaire. The participants answered each item in the questionnaire as it applied to their preferred learning style: accommodating, converging, diverging, or assimilating. Results were then analyzed and compared between each subspecialty and the previously reported preferred styles of otolaryngology residents., Results: Ten PO and 20 ON fellows completed the survey, with an overall response rate of 75%. PO and ON fellows (60% of each group) preferred a learning style that was "balanced" across all four styles. For ON fellows, 35% preferred converging and 5% preferred accommodating styles. For PO fellows, converging and accommodating styles accounted for 20% each., Conclusions: It was previously reported that 74.4% of otolaryngology residents prefer either converging or accommodating styles. We believe that the fellowship training environment calls for fellows to use more than one learning style to become proficient physicians, hence the trend toward potentially developing a balanced style when at this level., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)

Background: Recessive mutations of fibroblast growth factor 3 (FGF3) can cause LAMM syndrome (OMIM 610706), characterized by fully penetrant complete labyrinthine aplasia, microtia and microdontia., Methods: We performed a prospective molecular genetic and clinical study of families segregating hearing loss linked to FGF3 mutations. Ten affected individuals from three large Pakistani families segregating FGF3 mutations were imaged with CT, MRI, or both to detect inner ear abnormalities. We also modeled the three dimensional structure of FGF3 to better understand the structural consequences of the three missense mutations., Results: Two families segregated reported mutations (p.R104X and p.R95W) and one family segregated a novel mutation (p.R132GfsX26) of FGF3. All individuals homozygous for p.R104X or p.R132GfsX26 had fully penetrant features of LAMM syndrome. However, recessive p.R95W mutations were associated with nearly normal looking auricles and variable inner ear structural phenotypes, similar to that reported for a Somali family also segregating p.R95W. This suggests that the mild phenotype is not entirely due to genetic background. Molecular modeling result suggests a less drastic effect of p.R95W on FGF3 function compared with known missense mutations detected in fully penetrant LAMM syndrome. Since we detected significant intrafamilial variability of the inner ear structural phenotype in the family segregating p.R95W, we also sequenced FGF10 as a likely candidate for a modifier. However, we did not find any sequence variation, pointing out that a larger sample size will be needed to map and identify a modifier. We also observed a mild to moderate bilateral conductive hearing loss in three carriers of p.R95W, suggesting either a semi-dominant effect of this mutant allele of FGF3, otitis media, or a consequence of genetic background in these three family members., Conclusions: We noted a less prominent dental and external ear phenotype in association with the homozygous p.R95W. Therefore, we conclude that the manifestations of recessive FGF3 mutations range from fully penetrant LAMM syndrome to deafness with residual inner ear structures and, by extension, with minimal syndromic features, an observation with implications for cochlear implantation candidacy.

Coagulopathy is one of the relative contraindications to percutaneous dilational tracheostomy (PDT). We conducted a retrospective analysis of the records of 483 patients who had undergone PDT at Johns Hopkins Hospital from January 2000 through December 2007 to investigate the safety of PDT in those who were coagulopathic. The number of patients classified as coagulopathic varied greatly according to the particular diagnostic criteria used; 164 patients (33.95%) met one of the three diagnostic criteria (an abnormality in either prothrombin time, partial thromboplastin time, or platelet count), and 32 patients (6.63%) met two or three of these criteria. Complications occurred in 16 patients (3.31%), none of whom met two or more diagnostic criteria; bleeding accounted for 5 of these complications (1.04%). No statistically significant difference was seen in complication rates between the coagulopathic patients and the controls (noncoagulopathic patients). We conclude that in the hands of an experienced surgeon, PDT can be safely performed in patients with abnormal coagulation factors provided that the surgical team strictly adheres to a standardized protocol.

Objective: To perform risk analysis of tracheal injuries caused by endotracheal intubation (ETI) and to estimate the financial impact of these sequelae., Study Design: Cost analysis using a national database., Settings: The Agency for Healthcare Research and Quality (AHRQ) 2006 National Inpatient Sample., Subjects and Methods: We identified clinical manifestations and treatments of complications associated with endotracheal tubes and codified them into International Classification of Disease-ninth revision diagnosis and procedure codes, intentionally excluding alternative etiologies of tracheal injury. Using the AHRQ 2006 National Inpatient Sample, we then compared patients with tracheal injury coded during the medical or surgical stay for length of stay (LOS) and mean hospital cost with diagnosis-related group (DRG)-matched controls; we also examined readmissions treating tracheal injury., Results: Tracheal injury presents as tracheal stenosis, tracheomalacia, tracheoesophageal fistula, laryngotracheal ulceration, and vocal cord paralysis. A total of 3232 discharge records met criteria for tracheal injury from ETI within the index hospital stay. Average LOS for patients with tracheal injury (6.3 days; 95% confidence interval [CI] 6.0-6.3) exceeded LOS in the uncomplicated sample (5.2 days; CI 5.1-5.3) by 1.1 days. The average hospital cost was $1888 higher with tracheal injury ($10,375 [CI $9762-$10,988] vs $8487 [CI $8266-$8669]). LOS for procedures treating prior tracheal injury averaged 4.7 days and cost an average of $11,025 per discharge., Conclusion: Tracheal injury from ETI is associated with a significant increase in healthcare costs that accrue both during the index admission and during subsequent hospitalizations required to treat the injury., (2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.)

Bone is the most preferred site for metastatic dissemination in breast cancer. The purpose of this study was to examine the expression of a set of antibodies that could serve as predictive biomarkers associated with breast cancer metastasis in a subset of sixteen (16) breast cancer patients who developed bone metastasis. The clinical and pathologic data were obtained, and tissue microarrays were constructed. Tissue microarray slides were stained for TFF-1, CXRC4, MMP1, PTHrP, HER2, CD44, FGFR3 and IL-11. The expression rates were compared between the metastatic breast cancer to bone (MBC-B) group and a group of sixty-four (64) primary breast cancer (PBC). The results demonstrated that MBC-B group patients were more likely to be HER2 positive (P = 0.016). There was no significant difference on estrogen receptor or progesterone receptor expression between MBC-B group and PBC group (P > 0.05). There was a high expression of CXCR4, MMP-1, CD44, TFF-1, PTHrP, FGFR3 and IL-11, in both, PBC and MBC-B, and no significant differences between the groups were identified. We found that tumors associated with bone metastasis tended to be larger than 2 cm. The high morbidity associated to metastatic breast cancer prompts the identification of predictive biomarkers of relapse of breast tumors to categorize patients at high risk of bone metastasis and serve as targeted therapy.

Objective: To assess the effect of primary treatment on tracheoesophageal voice prosthesis (TEP) complications., Design: Retrospective cohort study., Setting: The Johns Hopkins Medical Institutions, Baltimore, Maryland., Patients: Patients who underwent total laryngectomy and TEP between January 1, 1998, and December 31, 2008, were divided into 3 subgroups according to primary treatment: surgery (n = 81), radiotherapy (n = 61), and chemoradiotherapy (n = 32)., Main Outcome Measures: Number of weeks before leakage through the TEP, occurrence of leakage around the TEP, TEP dislodgement, and size changes 6 months or longer after laryngectomy., Results: A total of 174 patients met the study criteria. Of the 81 patients who underwent primary surgery, 81% (n = 66) underwent adjuvant therapy with postoperative radiotherapy or chemoradiotherapy. The incidence of leakage around the prosthesis, prosthesis dislodgement, and size changes 6 months or longer after laryngectomy were significantly higher for patients who required salvage total laryngectomy after chemoradiotherapy or radiotherapy (P < .05). In addition, significantly more patients who underwent salvage total laryngectomy required extended laryngectomy or free tissue reconstruction., Conclusions: Voice prosthesis complications are more frequently encountered in those who require salvage laryngectomy. Understanding the potential for such complications reinforces the need for close communication and follow-up with these patients by the speech language pathologist.

Competency-based surgical residency training is rapidly becoming the norm across surgical specialties. Ensuring that graduating surgeons are competent to deliver the necessary services and skills to their patients remains a seminal objective of training programs. Defining surgical competence, the measures used to assess and quantify that competence, and the criteria used to judge whether it has been achieved are critical issues. The bar that surgical residency programs have established is, and must continue to be, set very high. Definitions of competency differ across disciplines. In education, two approaches are recognized. According to the behaviorist approach, competence is assessed by precise measures of performance, generally documented by checklists. The integrated (holistic) approach defines competence as a complex combination of personal attributes. Assessments of competence also fall under two categories: the traditional scientific paradigm, emphasizing objectivity and reproducibility, and the judgment paradigm, reflecting the need to assess clinical competence in the final stages of medical training. In surgery, competence is the ability to successfully apply professional knowledge, skills, and attitudes to new situations as well as to familiar tasks. A critical step in assessing surgical competency is developing methodology for competency evaluation and certification. Matching different aspects of surgical competency with the appropriate assessment instruments is the theme of the contemporary evaluation process, with emphasis on a whole-task approach and the assessment of professional judgment. An effective assessment program will incorporate several competency elements, using multiple sources of information to assess competencies on multiple occasions, at various levels, and in different settings.

We previously reported that new beta cells differentiated in pancreatic islets of mice in which diabetes was produced by injection of a high dose of the beta cell toxin streptozotocin (SZ), which produces hyperglycemia due to rapid and massive beta cell death. After SZ-mediated elimination of existing beta cells, a population of insulin containing cells reappeared in islets. However, the number of new beta cells was small, and the animals remained severely hyperglycemic. In the present study, we tested whether restoration of normoglycemia by exogenous administered insulin would enhance beta cell differentiation and maturation. We found that beta cell regeneration improved in SZ-treated mice animals that rapidly attained normoglycemia following insulin administration because the number of beta cells per islet reached near 40% of control values during the first week after restoration of normoglycemia. Two presumptive precursor cell types appeared in regenerating islets. One expressed the glucose transporter-2 (Glut-2), and the other cell type coexpressed insulin and somatostatin. These cells probably generated the monospecific cells containing insulin that repopulated the islets. We conclude that beta cell neogenesis occurred in adult islets and that the outcome of this process was regulated by the insulin-mediated normalization of circulating blood glucose levels.

The essential Sth1p is the protein most closely related to the conserved Snf2p/Swi2p in Saccharomyces cerevisiae. Sth1p purified from yeast has a DNA-stimulated ATPase activity required for its function in vivo. The finding that Sth1p is a component of a multiprotein complex capable of ATP-dependent remodeling of the structure of chromatin (RSC) in vitro, suggests that it provides RSC with ATP hydrolysis activity. Three sth1 temperature-sensitive mutations map to the highly conserved ATPase/helicase domain and have cell cycle and non-cell cycle phenotypes, suggesting multiple essential roles for Sth1p. The Sth1p bromodomain is required for wild-type function; deletion mutants lacking portions of this region are thermosensitive and arrest with highly elongated buds and 2C DNA content, indicating perturbation of a unique function. The pleiotropic growth defects of sth1-ts mutants imply a requirement for Sth1p in a general cellular process that affects several metabolic pathways. Significantly, an sth1-ts allele is synthetically sick or lethal with previously identified mutations in histones and chromatin assembly genes that suppress snf/swi, suggesting that RSC interacts differently with chromatin than Snf/Swi. These results provide a framework for understanding the ATP-dependent RSC function in modeling chromatin and its connection to the cell cycle.