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Jordan, located in the Levant region, is an area crucial for the investigation of human migration between Africa and Eurasia. However, the genetic history of Jordanians has yet to be clarified, including the origin of the Bedouins today resident in Jordan. Here, we provide new genetic data on autosomal independent markers in two Jordanian population samples (Bedouins and the general population) to begin to examine the genetic diversity inside this country and to provide new information about the genetic position of these populations in the context of the Mediterranean and Middle East area. The markers analyzed were 18 Alu polymorphic insertions characterized by their identity by descent, known ancestral state (lack of insertion), and apparent selective neutrality. The results indicate significant genetic diffferences between Bedouins and general Jordanians (p = 0.038). Whereas Bedouins show a close genetic proximity to North Africans, general Jordanians appear genetically more similar to other Middle East populations. In general, these data are consistent with the hypothesis that Bedouins had an important role in the peopling of Jordan and constitute the original substrate of the current population. However, migration into Jordan in recent years likely has contributed to the diversity among current Jordanian population groups., (Copyright © 2014 Wayne State University Press, Detroit, Michigan 48201-1309.)

The number of non-neurofibromatosis type 2 (NF2) indications for auditory brainstem implant (ABI) in the literature is increasing. The objective of this study was to analyze and discuss the indications for ABI. Retrospective chart review and systematic review were conducted at Quaternary referral skull base center and referring centers. Analysis of ABI cases with non-NF2 indications and systematic review presenting non-NF2 ABI cases were performed. Fourteen referred cases with ABI were identified. All cases had unsatisfactory results of ABI and all could have been rehabilitated with a cochlear implant (CI). Of these 14 cases, 9 improved with a cochlear implant, and 2 with a hearing aid, two are still planned for CI, one received bilateral CI, no ABI. In literature, we found 31 articles presenting 144 non-NF2 ABI cases with at least 7 different indications other than NF2. ABI should be restricted to those patients who have no other rehabilitation options. Patency of the cochlea and evidence of an intact cochlear nerve should be examined with imaging and electrophysiologic testing. Sometimes a CI trial should be planned prior to proceeding with ABI. We have shown that in many cases a CI is still possible and CI provided better results than ABI. In vestibular schwannoma in the only hearing ear, cochlear otosclerosis, temporal bone fractures, (presumed) bilateral traumatic cochlear nerve disruption, auto-immune inner ear disease and auditory neuropathy primarily CI are indicated. Traumatic bilateral cochlear nerve disruption is exceptionally unlikely. In cochlear nerve aplasia, testing should be performed prior to meeting indications for ABI. In malformations, ABI is indicated only in severe cochlear hypoplasia or cochlear aplasia.

The objectives of this study were to evaluate the dry matter intake (DMI), digestibility, average daily gain (ADG), microbial efficiency, empty body weight (EBW) gain, and body composition of Nellore bulls. Additionally, Nellore bull maturity was estimated, and the prediction equation for DMI, suggested by the Brazilian nutrient requirements system (BR CORTE; Azevêdo et al. 2010), was evaluated. Thirty-three Nellore bulls, with a mean initial weight of 259 ± 25 kg and age of 14 ± 1 months, were used in this study. Five animals were slaughtered at the beginning of the experiment (control group), and the remaining 28 were divided into 4 groups, each slaughtered at 42-day intervals. Their diet was composed of corn silage and concentrate (55:45). The power model was used to estimate muscle tissue, bone tissue, crude protein (CP), mineral matter (MM), and water present in the empty body, while the exponential model was used to estimate adipose tissue and ether extract (EE) present in the empty body. When expressed in kilograms per day, differences were observed (P < 0.05) only for the intake of EE and neutral detergent fiber as a function of feedlot time periods. Although there was a difference in relation to nutrient intake, it did not affect (P > 0.05) digestibility, with the exception of EE digestibility. The equation suggested by BR CORTE correctly estimates the DMI of Nellore bulls. ADG was not affected (P > 0.05) by time spent in the feedlot. No differences were observed (P > 0.05) for microbial efficiency; a mean value of 142 g microbial crude protein/kg total digestible nutrients was achieved. The muscle and bone tissues, CP, MM, and water present in the empty body increased as the animal grew, although at a lower rate. The adipose tissue and EE present in the empty body increased their deposition rate when the animal reached its mature weight. Maturity is defined as when an animal reaches 22 % EE in the empty body, which corresponds to 456 kg of EBW in Nellore bulls. Therefore, this study can conclude that the feedlot time period does not affect DMI, nutrient intake, ADG, or microbial efficiency. The equation proposed by BR CORTE (Azevêdo et al. 2010) correctly estimates the DMI of Nellore bulls, which reach maturity when an EBW of 456 kg is attained.

In this clinical note we discuss the indications, feasibility, and outcomes of binaural simultaneous cochlear implantation (CI) following bilateral transverse temporal bone (TB) fractures. A 41-year-old male, totally deaf after a bilateral TB fracture, underwent an audiological, electrophysiological, and imaging investigation in order to assess the integrity of the VIIIth cranial nerves. Five months later he received a simultaneous bilateral CI. Speech perception tests were conducted at different time points. A significant advantage by dichotic listening was observed since the beginning of the habilitation program. The patient achieved a 100% word and sentences recognition in quiet at 12 months. His listening skills in noisy conditions were improved by the use of two implants. A CI in TB fractures is feasible if the VIII nerve is intact and the cochlea is spared by the fracture rim. The early timing of the procedure probably contributed to its success by preventing cochlear fibrosis and ossification.

Pontine tegmental cap dysplasia (PTCD) is an exceptionally rare brain stem and cerebellar malformation characterized by ventral pontine hypoplasia, vaulted pontine tegmentum, hypoplasia of the vermis, subtotal absence of middle cerebellar peduncles, lateralized course of the superior cerebellar peduncles, and absence or alteration of the inferior olivary nucleus. The main clinical features are multiple cranial neurophaties and ataxia. Sensorineural hearing loss of varying severity is almost always present. To date, 14 cases of PTCD have been reported in the literature. We present a child with PTCD and profound bilateral sensorineural hearing loss who underwent cochlear implantation. To the best of our knowledge, cochlear implantation in PTCD has not been previously reported. Functional outcome was assessed using the Speech Perception Categories and the Speech Intelligibility Rating scale. At 22 months' postoperative evaluation, the patient who was placed into speech perception category 0 (no detection of speech) preoperatively progressed to category 3 (beginning word identification). Before implantation, the child had connected speech unintelligible. At the last follow-up, she had connected speech intelligible to a listener who has little experience of a deaf person's speech. Cochlear implantation allowed this child to improve her quality of life, increasing her self-confidence, independence, and social integration.

Objectives: To report of a 65-year-old woman with bilateral Meniere's disease was referred for cochlear implantation (CI) due to severe/profound sensorineural hearing loss., Methods: During the assessment workup, a vestibular schwannoma in the right ear was found by MR imaging. She underwent a translabyrinthine removal of the acoustic neuroma (AN) with sparing of the cochlear nerve and concurrent ipsilateral CI with a Nucleus Freedom device (Cochlear Ltd., Lane Cove, New South Wales, Australia)., Results: Complete removal of the AN was achieved without complications. Neural Response Telemetry (NRT) measurements, which showed poor morphology at the intraoperative tests, rapidly improved after activation, similarly to electrically evoked auditory brainstem responses (E-ABR). The patient reached 100% speech perception performances within 2 months from implantation, in the monaural condition. She was relieved from vertigo spell up to 14 months after the operation., Conclusion: Cochlear implantation at the time of acoustic neuroma removal with VIII nerve sparing can be a safe and effective hearing restoration procedure.

Conclusions: We observed 4 cases of paroxysmal positional vertigo (PPV) among 62 cochlear implant (CI) recipients. They occurred in the implanted ear without chronological relation with the surgical procedure or the implant's activation. All of them relapsed within 3 months after an initially successful repositioning maneuver, and finally recovered after the second one. None of the patients showed labyrinthine weakness in the implanted ear. The outbreak of PPV did not affect the patients' speech perception performances., Objectives: To report and discuss the occurrence of PPV after cochlear implantation., Patients and Methods: Among 32 adult patients who received a Nucleus CI, 4 suffered from PPV on the basis of Dix-Hallpike's maneuvers. After a Semont's repositioning maneuver, recurrences were similarly addressed. An electro-nystagmography (ENG) recording of caloric irrigation tests was obtained once the symptoms subsided., Results: The observed incidence of 12.5% exceeds the figures reported in the literature. No anatomic abnormalities were identified in these patients, nor were any intraoperative or postoperative complications reported. PPV developed 1-12 months after CI surgery in the posterior canal and relapsed within 3 months. ENG showed a normal reflectivity in two patients, while the other two had a significant prevalence of the implanted side. The outcomes of the speech perception tests after CI in all the four patients matched those of their corresponding categories.

Objective: To report on the outcomes of cochlear implantation (CI) in a child with cochleovestibular nerves (CVN) hypoplasia., Study Design: Retrospective case review., Setting: Tertiary referral center, University hospital., Patients: An 18-month-old child with profound bilateral congenital hearing loss and bilateral hypoplasia of the CVN at imaging., Intervention: Left CI at age 29 months with a Nucleus Contour device (Cochlear Ltd., Lane Cove, New South Wales, Australia) after unsatisfactory results of hearing aid use for 10 months., Main Outcome Measures: Speech perception tests, behavioral observation, electrophysiologic tests, and cognitive evaluation., Results: Although the child scores poorly in every perceptive category with the CI alone, the device greatly enhances his speech understanding with the hearing aid in the opposite ear. In the bimodal condition, his words and sentences identification, recognition, and comprehension far exceed the monaural figures. The Meaningful Auditory Integration Scale (MAIS) tests reaches a score of 26/40, and the MacArthur's questionnaires confirm the improvement of language production and comprehension. These results became noticeable after 5 to 6 months and continued to improve up to the 10th month. The child's cognitive scores and overall performance competences greatly benefit from the CI, with the mental age overcoming the chronological age., Conclusion: We can confirm the chance of achieving satisfactory results by CI even when the imaging of CVN is doubtful and the electrophysiological tests are disappointing. In our experience, a CI in Type IIb dysplasia of the CVN is a feasible option, provided that the candidate shows some responses at aided audiogram and at least minimal signs of language development. Adequate counseling is necessary for these children because the expected outcome is somewhat lower than that of their deaf peers with normal appearance of the nerves.

Objective: To review the clinical charts of 45 paediatric patients treated for acute otomastoiditis at the ORL Department of the University of Brescia (Italy) between January 1994 and March 2005 and to discuss the diagnostic workup and the outcome of treatment., Methods: Twenty-six males and 19 females were admitted with acute mastoiditis and subperiosteal abscess. Thirteen of them (28.9%) presented an intracranial complication. Only three of them were not operated upon; one received a ventilation tube (VT); all the others underwent a mastoidectomy within 48-72 h. Twenty out of 32 uncomplicated mastoiditis were treated conservatively and the remaining 12 underwent myringotomy+/-VT, associated with a mastoidectomy in 9 cases., Results: Antibiotics alone or with VTs achieved a full recovery in 28 out of 32 uncomplicated cases. Mastoidectomy resolved the disease in 13 patients (9 with complications). In severe complications, a canal wall down (CWD) (n=2) or an intact canal wall (ICW) mastoidectomy (n=7) were preferred, based on the extent of the lesions and the degree of hearing loss. All children recovered completely at 1 year follow-up. In the uncomplicated cases that were operated upon, the mean hospital stay was 7.8 days (versus 4.3 days for the conservative group). In children with intracranial complications the mean hospital stay was 12.8 days, significantly less than the four non-surgical patients, who remained hospitalized for an average of 18 days., Conclusion: Acute mastoiditis can fully recover with conservative treatment or myringotomy+VTs. Immediate surgical treatment is indicated for intracranial complications, if the neurological conditions are not critical. A simple mastoidectomy+/-tympanoplasty is warranted in: (1) exteriorization, if the child is older than 30 months or >15 kg of weight, (2) intracranial complications (combined with a neurosurgical procedure as needed) and (3) cholesteatoma or granulation tissue.

Deep neck abscesses are life-threatening conditions, in early stages preferably treated by intravenous antibiotic therapy; in advanced stages, surgical drainage is mandatory. We report two cases of retro-parapharyngeal abscess with prevalent retronasopharyngeal extension in two men aged 60 and 82, both of whom underwent transnasal endoscopic drainage. The main surgical steps were incision of the posterior pharyngeal mucosal wall, widening of the incision, drainage of purulent collection and careful dissection and removal of the necrotic tissue. The first patient, with an abscess associated with chronic otitis media and presenting hypoglossal nerve palsy, quickly recovered from pharyngodinia, otalgia and trismus. Twenty-six months after surgery, he is symptom-free, with hemitongue atrophy due to denervation as the only residual sign. The second patient, affected by skull base osteomyelitis secondary to malignant external otitis, after a first successful drainage, underwent a second endoscopic procedure for the reoccurrence of an abscess in the contralateral retroparapharyngeal space. Twelve months after the first surgery, the patient reported an improvement of symptoms, except for persistent dysphonia related to vagal nerve palsy. At follow-up MR, another abscess was detected in the left retro-parapharyngeal space. In selected cases of abscess, transnasal endoscopic drainage may be an effective alternative to external approaches. Minimal morbidity, the absence of cervical or palatal scars and a short hospitalization time can be considered as important advantages in comparison to external approaches. Patients with abscess secondary to skull base osteomyelitis require close imaging surveillance because of the difficulty of definitive control of the disease.

Objective: The aim of this study was to test the bioequivalence of two alendronate tablets (CAS 121268-17-5; Marvil 10 and Marvil 70 as test formulations, in short "test"; reference formulation, in short "reference") in vitro and in vivo in healthy adult male subjects and to describe a mode for researching the bisphosphonate oral formulation pharmaceutical quality., Methods: Two dissolution tests with 10-mg and 70-mg alendronate tablets, a preliminary clinical test with 10-mg tablets (n = 10) and a bioequivalence study with 70-mg tablets (n = 23) were performed. Clinical studies were single-dose, open, cross-over, randomized, including a four-week wash-out period. Alendronate was assessed by HPLC in urine after 6 (UE6) and 24 (UE24) h post-intake. In all the experiments the reference was the one that had proved efficacy and safety in international regulatory clinical trials., Results: The dissolution test showed a comparable release profile between reference and test, of both, the 10-mg and 70-mg tablet, the difference (f1) and similarity (f2) factors being within the acceptance values. The clinical trials showed great variability in urinary recovery, from one third the average figure up to 2-3 fold. The amount recovered with the 70-mg tablet was 11-15 fold higher than with the 10-mg tablets, suggesting higher (test/reference) was found to be 72-122% for UE24, and when analyzed in individuals with apparent steady bone metabolism during the wash-out period (n = 19), it was 86-137%. Both margins are considered acceptable in view of the particular kinetic and dynamic features of bisphosphonates, their very high inter- and intra-individual variability, extremely low absorption, time-changeable bone compartment, high margin of safety and long-term achievable therapeutic benefits., Conclusion: Test is bioequivalent to reference.

Objective: To analyze the closure time of diode laser-assisted myringotomies, the incidence of complications, and the hearing results in comparison with the "cold" procedure in adults with otitis media with effusion (OME)., Study Design: Prospective case-control study., Setting: Tertiary referral center, university hospital., Patients: Twenty-eight adult patients (39 ears), 13 men and 15 women, age 13 to 76 years (mean, 51.9). Inclusion criteria included 3 months (or more) history of OME resistant to medical therapy. Twenty-two control patients (34 ears) underwent cold myringotomies with knife and ventilation tubes (VT)., Intervention: Diode laser myringotomy performed in an office setting under local anesthesia with topical EMLA ointment., Main Outcome Measures: Timing of closure of the myringotomy, hearing results, incidence of complications, recurrence of OME., Results: No intra- or postoperative pain nor complications were observed. Otomicroscopic daily monitoring documented the healing patterns of the tympanostomies, which remained patent for 7 to 25 days (average, 15.6 +/- 4.8 days). Immediate improvement of hearing was achieved in every patient. Recurrence of OME was observed in 36 ears (92.3%) within 1 month from healing. In the control group with VTs, healing of the eardrum was observed between 126 and 301 days (average, 183.2 +/- 44.8 days), and recurrence of OME was observed in 8 ears (23.5%) (p < 0.001). One month after healing, the air-bone gap was retained within 10 dB in 10.3% (4/39) of the diode laser group and in 50% (17/34) of the standard procedure group (p=0.0001)., Conclusions: Diode laser myringotomy is a straightforward, painless procedure simplified by the thin fiberoptic cables available. Functional benefit is comparable to conventional tympanostomies plus VTs, but the duration of patency is too short to achieve long-term clearance of the effusion in "glue" ears of adult patients. Selected indications could be acute or recurrent otitis media or the prevention of barotraumas in tubal dysfunction.

Oxysterols are common components of oxidized low-density lipoprotein and accumulate in the core of fibrotic plaques as a mixture of cholesterol and cholesteryl ester oxidation products. The proapoptotic effects of a biologically representative mixture of oxysterols was compared with equimolar amounts of 7-ketocholesterol and unoxidized cholesterol. The oxysterol mixture in a concentration range actually detectable in hypercholesterolemic patients did not stimulate programmed cell death in cultivated murine macrophages. Unoxidized cholesterol also produced no effect. By contrast, when given alone, 7-ketocholesterol strongly stimulated the mitochondrial pathway of apoptosis with cytochrome c release, caspase-9 activation, and eventually caspase-3 activation. Subsequent experiments showed that when 7-ketocholesterol was administered to cells together with another oxysterol, namely 7betaOH-cholesterol, the strong proapoptotic effect of 7-ketocholesterol was markedly attenuated. As regards the mechanism underlying this quenching, we found that the combined oxysterol treatment counteracted the ability of 7-ketocholesterol, when administered alone, to strongly up-regulate the steady-state levels of reactive oxygen species (ROS) without interfering with sterol uptake. Furthermore, this increase in intracellular ROS appeared to be responsible for the up-regulation of proapoptotic factor, p21, after treatment with 7-ketocholesterol but not in cells challenged with the oxysterol mixture. Competition among oxysterols, apparently at the level of NADPH oxidase, diminishes the ROS induction and direct toxicity that is evoked by specific oxysterols. As a consequence, a more subtle gene modulation by oxysterols becomes facilitated in vascular cells.

L-sulpiride is the levorotatory enantiomer of sulpiride, a neuroleptic of the family of benzamide derivatives; it has a characteristic antagonist effect on central DA2 dopaminergic receptors and dopamine DA1 "autoreceptors". Its efficacy in the symptomatic control of acute vertigo spells has been recognized, apart from its well-known antiemetic, antidyspeptic and anti-depressant properties, at high dosages. To establish objective parameters of the results of its clinical application, a randomized prospective study was started comparing the effects of the drug in a group of 87 patients with vertigo of peripheral origin, with those in a control group treated with other vestibular suppressants. The drug was administered via the intravenous route, 25 mg t.i.d., for the first 3 days, then by oral administration, with the same schedule and dosage, for a further 7 days. After clinical evaluation of vestibular signs and symptoms, electronystagmographic recordings of rotatory tests were obtained, at admission and were then controlled after 6 months. A subjective Visual Analogue Scale was also delivered daily to the patients in order to monitor symptomatic improvements. When compared to conventional treatments, L-sulpiride appeared to induce a statistically significant faster recovery in unilateral vestibular lesions. An unexpected favourable outcome of treatment was the facilitation of spontaneous vestibular compensation, in terms of lesser residual labyrinthine dysfunction and reduction of recurrent vertigo attacks during the 6 months follow-up. The mechanisms of action of the drug and its interaction with the vestibular system are discussed.

Inflammatory myofibroblastic tumors include a diverse group of lesions characterized by inflammatory cell infiltration and variable fibrotic responses. Occurrence in the temporal bone is unusual. We present CT and MR imaging findings of an inflammatory myofibroblastic tumor of the temporal bone in a 26-year-old patient with repeated paroxystic episodes of rotatory vertigo that occurred over a few days. CT and MR imaging revealed a homogeneously enhancing soft-tissue mass of the right mastoid with bone erosion of the tegmen and extensive dural thickening. The mass resembled a malignant tumor, and the patient underwent an extended mastoidectomy through a retroauricular approach. Microscopic examination showed myofibroblastic spindle cells with mixed inflammatory infiltrate, and the pathologic diagnosis was inflammatory myofibroblastic tumor.

In vivo studies on human colon adenocarcinoma showed decreased transforming growth factor-beta1 (TGF-beta1) antiproliferative cytokine content in tumour tissue related to malignancy progression, with a corresponding decrease in lipid peroxidation aldehydic end-product, 4-hydroxynonenal (HNE). The tumour mechanism to escape TGF-beta1-mediated growth inhibition may be due to an altered TGF-beta1 receptor system. Subsequent in vitro analyses showed a differential distribution of TGF-beta1 receptors depending on the human colon cancer cell line considered (CaCo-2 or HT-29): compared to HT-29 cells, CaCo-2 cells showed a decrease of the two main TGF-beta1 receptors, RI and RII. Notwithstanding their partial TGF-beta1 RI and RII deficiency, treatment of CaCo-2 cells with adequate doses of the cytokine (10 ng/ml) was able to induce apoptosis. Of note, co-treatment of these cells with 1 microM HNE increased the apoptotic effect. The constant low concentration of TGF-beta1 in the tumour mass may be related to the low content of antiproliferative HNE observed in colon cancer: the latter phenomenon, which reduces TGF-beta1 production in the tumour area, may represent a favourable condition for neoplastic progression. The enhancement of TGF-beta1-induced apoptosis by HNE in CaCo-2 cells supports this hypothesis. The different transcriptional components regulated by the distinct signaling pathways of these two molecules might be proposed; in particular, crosstalk between the MAPK and the Smad pathway could modulate and co-operate in the transcription of target genes involved in regulation of cell proliferation.

This prospective open pilot study was designed to assess the suitability of flexible composite sheets of polymer and hydroxyapatite (HA) for the reconstruction of limited lateral skull base defects through a conservative transmastoid approach.Seven patients with a petrous bone dehiscence less than 3 cm in diameter, either iatrogenic or caused by chronic otitis media or temporal bone trauma, underwent a mastoidectomy. The defect was repaired with the new material and a connective tissue graft. All bone defects were detected by computed tomography (CT) of the temporal bone except one that was found at surgery in an asymptomatic patient.Outcome was evaluated in terms of anatomical integrity of the tegmina, absence of cerebrospinal fluid leaks, side effects, and extrusion and complication rates. None of the patients suffered from immediate side effects related to the implant or the operation. With a minimum follow-up of 18 months (maximum, 62 months), neither extrusion nor a foreign body reaction occurred. Postoperative CT confirmed a satisfactory anatomic contour. Although the number of patients is limited, these preliminary results are encouraging and indicate a need for further clinical trials with a material that allows a minimally invasive approach to selected skull base defects.

Background: During neoplastic progression, alterations in transforming growth factor beta1 (TGF-beta1) dependent control of cell growth may be an important mechanism of selective proliferation of transformed cellular clones. Defective regulation of TGF-beta1 receptors has been reported to occur in a number of human malignant tumours while little is known of the actual levels of this growth inhibitory cytokine in cancer. On the basis of the demonstrated ability of major lipid peroxidation products such as 4-hydroxynonenal to modulate TGF-beta1 expression and synthesis, we speculated that decreased lipid oxidation, as frequently observed in neoplastic tissues, would contribute to the selective promotion of tumour growth through decreased expression of the cytokine within the tumour mass., Aims: To seek a possible association between steady state levels of major aldehydic end products of lipid peroxidation and TGF-beta1 content in human colon cancer at different stages of growth., Patients and Methods: Tissue biopsies from 15 adult patients with colon adenocarcinoma of different TNM and G stagings were compared with regard to lipid peroxidation aldehydes and net TGF-beta1 levels. For a more comprehensive analysis, cytokine type I and II receptors were measured in tumour biopsies. In one set of experiments, to support the conclusions, the apoptotic effect of TGF-beta1 was evaluated in a human colon cancer cell line, CaCo-2, retaining receptor changes consistent with those observed in cancer patients., Results: With the exception of two extremely advanced cases (T4/G3) in which tissue levels of lipid peroxidation were within the normal range, 4-hydroxynonenal was significantly decreased in all other cancer specimens. Consistent with lipid peroxidation levels, TGF-beta1 protein was markedly decreased or even negligible compared with the corresponding normal tissue surrounding the tumour in all tested biopsies except for the two T4/G3 colon cancers in which cytokine content was again within the normal range. As regards TGF-beta1 receptors, both in tumour sections and CaCo-2 cells, downregulation was greater for TGF-beta1 receptor I than for receptor II. Of note, in CaCo-2 cells, incubation with appropriate doses of TGF-beta1 led to marked nuclear fragmentation and apoptosis., Conclusions: Evasion of human colon cancer cells from TGF-beta1 mediated growth inhibition appears to be due not only to downregulation of TGF-beta1 receptors, which is inconsistent and unrelated to cancer development, but also to the constant low concentration of this cytokine in the tumour mass. The associated levels of lipid peroxidation aldehydes, much lower than in control tissue, probably represent a lower stimulus for TGF-beta1 production in the neoplastic area and thus a favourable condition for neoplastic progression.

Objective: To evaluate the effectiveness of two methods of dental health education (DHE) for improving toothbrushing competency among grade one students at high risk for dental diseases., Methods: Fifty elementary schools in the former city of North York, Ontario, Canada, were assigned to one of two groups. In one group, students received a classroom-based DHE lesson that was reinforced by two small group sessions (n = 243). In the other group, students received only a single classroom-based DHE lesson (n = 206). Trained examiners assessed 11 toothbrushing skills at pre- and postintervention., Results: At the preintervention test, few significant differences were found between the groups and many students did not display competency in fundamental oral health skills, such as placing a toothbrush at the gum line. Following DHE interventions, students in both groups demonstrated improvements in most skills. A significantly higher proportion of students who received both classroom and small group sessions displayed gains in competency in three skills, compared to students receiving only a classroom lesson. These skills were brushing anterior lingual surfaces, brushing posterior lingual surfaces, and brushing all areas in a routine fashion. Students receiving only a classroom session did not display greater improvements in any skill areas compared to "classroom plus small group" students. Some students in both groups still lacked fundamental skills at the end of the DHE program., Conclusions: While one must exercise caution in interpreting the results due to several methodologic limitations, findings suggest that for high-risk grade one students, a classroom-based lesson combined with small group sessions is a more effective method of improving toothbrushing skills compared to a single classroom-based lesson.

Pulsating tinnitus is uncommon in the general population. This clinical manifestation can be associated with severe intracranial pathologies and is particularly characterized by a rhythm and synchronism reflecting the heart beat. This work presents a clinical case of pulsating, subjective tinnitus associated with a high homolateral jugular bulb and marked hypoplasia of the contralateral transverse and sigmoid sinuses and the clinical-radiological examinations that made diagnosis possible (particular reference going to CT, MRI and angio-MRI). The intracranial venous drainage pattern varies and is nearly always asymmetrical. The jugular bulb is defined as "high" when its upper edge extends nearly to the level of the tympanic anulus, a condition found in 6-20% of the general population. In many cases it is found by chance as often this condition is asymptomatic. However, the pathological picture associated with pulsating tinnitus is highly complex and requires a detailed diagnostic process which some Authors have arranged in specific "flow charts". Imaging methods are essential and must be identified according to the clinical-audiological findings. The radiologist can avail himself of CT, MRI (in association with angio-MRI), Doppler ultrasound of the supraortic and transcranial branches, and digital imaging subtraction angiography. The therapeutic approach to the patient manifesting a "high" jugular bulb is surgical and makes use of such procedures as: ligature of the internal jugular vein, extracranial transposition of the bulb and, in cases of dehiscence of the limiting bone, hypotympanum repair using an autologous or homologous graft of cartilage or bone. Whichever the case, an accurate cost-benefit evaluation must be made, particularly in regard to the risks of endocranial hypertension from the reduced venous drainage, a condition which is significantly increased when concomitant abnormalities of the dural sinuses are present. In the present case, this risk was quite high because of the particular venous morphology described and the patient refused surgery. Currently the patient is under clinical-radiological observation.

The effectiveness of two methods of dental health education (DHE) for improving oral hygiene knowledge among high-risk Grade One students was evaluated. Fifty elementary schools in the former City of North York, Canada were assigned to one of two groups. In one group, students received a classroom-based DHE lesson which was reinforced by two small-group sessions (n=243). In the other group, students received only a single classroom-based DHE lesson (n=206). After DHE interventions, students in both groups displayed improved knowledge for most oral hygiene questions (e.g., when should you throw your toothbrush away?). However, for several questions, a significantly higher proportion of "classroom plus small-group sessions" students displayed improved knowledge compared to students receiving only a classroom lesson. These items included: awareness that cavity prevention and removal of germs are two purposes of oral hygiene; and knowledge that teeth help people to eat and talk. Results suggest a classroom-based lesson combined with small-group sessions is a more effective method of improving oral hygiene knowledge among high-risk Grade One students compared to a single classroom-based lesson.

Oral nitrogen containing bisphosphonates (NCB) are effective drugs to inhibit bone metabolism turnover in osteoporosis and other bone diseases. Notwithstanding, some digestive disturbances create concern on the long term acceptance of the oral route. Side effects are mainly caused by low absorption and poor solubility in digestive content. Therefore the compound may precipitate and irritate the mucosas. Furthermore, the administered amount of a particular molecule, its intrinsic potency to irritate digestive walls and the degree of exposition to such sensitive tissue are other facts that combined, may determine the clinical tolerability. Thus, a single factor cannot predict the clinical tolerability. Pamidronate, alendronate and olpadronate are the main NCB under clinical usage. Alendronate is 10 times more potent than pamidronate but possesses a similar slight solubility (2.4 vs 3.0% W/V respectively). It also seems to be more (3 times fold) ulcerogenic in experimental assays. The current available pamidronate formulation protects from esophagus and gastric exposition. Up to now and until randomized clinical trials be performed the selection of the most tolerated aminobisphosphonate in clinical practice will depend on the interplay of many factors (table 1 shows a hypothetical view). Moreover, different patients may react dissimilarly depending on their sensitivity to a particular factor. Olpadronate is free-soluble (24% W/V), almost equipotent with alendronate (figure 1) and seems to lack relevant irritation potential, but clinical data is on its early phases and is still not available. Micronization of the bisphosphonate preparation may be of help to improve tolerability as shown with newer pamidronate oral formulations. The current clinical published data shows more or less the same safety profile for pamidronate (only when enteric coated capsules are used) as alendronate, with more than 90% of patients complying with long term treatments. Anyway the trials are not entirely comparable as said before. Some other pamidronate formulations proved to be intolerable and have not been accepted. Identifying the many factors of oral NCB's digestive tolerability may help with their clinical management. And in those countries where the two compounds are available they may alternatively be used in the sensitive patients. Finally, extra-digestive side effects, not commented in this article, should also be weighted when selecting a bisphosphonate.

The identification of a possible autoimmune etiology for a sensorineural hearing loss (SNHL) is essential for a successful medical treatment. Confirmation of diagnosis in clinically "high-risk" patients is provided by antigen-specific tests, which are not easily obtainable on a routine basis in the otologic clinic; on the other hand the reliability of non-specific-antigen tests is questioned. The outcome of serological tests in a group of patients with possible autoimmune SNHL were compared with those obtained in two control groups, one of normal subjects and one with systemic autoimmune disorders. The test battery included the dosage of circulating aspecific autoantibodies (anti-nuclear, anti-perinuclear factor, anti-mitochondrial, anti-smooth muscle), the total haemolytic activity (CH50), the immunoglobulin fractions and the aspecific inflammation indexes. At the p level of 0.05, none of the findings reached statistical significance, except for low CH50 in 31% of SNHL patients. Complement consumption is an indirect indicator of the presence of immunocomplexes. The serum dosage of the total haemolytic activity is suggested as screening. Investigation to detect circulating immunocomplexes is to be extended to patients with low CH50 levels.

The association between nasal cancer and work in the metal industry was investigated in a case-control study located in the province of Brescia, north eastern Italy. Thirty five cases of malignant epithelial neoplasms of the nasal cavity and paranasal sinuses who were resident in the province of Brescia and diagnosed or treated by the ear, nose, and throat department and the radiotherapy unit (Centro Alte Energie) of the Brescia Hospital in the years 1980-9 were included in the study. Controls (102) were patients affected by benign and malignant neoplasms of the head and neck who were resident in the Brescia Province and matched the cases by age and sex. All the subjects were interviewed by telephone. Metal workers showed an increased risk of nasal cancer (odds ratio (OR) 3.1; 90% confidence interval (90% CI) 0.48-20); a higher risk was associated with work in foundries (OR 5.9; 90 CI 0.77-46). Work in wood, leather, and textile industries was also associated with increased risk of nasal cancer.