Mastoid obliteration with S53P4 bioactive glass after canal wall down mastoidectomy: Preliminary results.

BACKGROUND: Bioactive glass (S53P4), abbreviated BG, currently seems to be the best material for reconstructing the posterior wall of the auditory canal and obliterating the postoperative cavity. PURPOSE: The aim of the study was to report preliminary results of otosurgery involving obliteration of the mastoid cavity after canal wall down mastoidectomy. METHODS: 11 adult patients who had had a history of chronic otitis media with cholesteatoma in one or both ears and previous canal wall down mastoidectomy. The duration of the follow-up was 6 months, with routine visits after 7 days, then 1, 3, and 6 months after surgery. The patient's medical history, noting other diseases potentially affecting the healing process, was analyzed. Healing, audiometric results, reduction of the volume of the cavity after surgery, and reduction of bacterial flora growth were assessed. RESULTS: There was not worsening in the audiological evaluation. Healing period was uneventful. There was a reduction in volume of the postoperative cavity, no development of pathological flora, and no recurrence of cholesteatoma. CONCLUSION: Obliteration of the mastoid process with S53P4 bioactive glass is a safe and effective method of treatment. Such a procedure should be considered as a treatment for patients after canal wall down surgery (CWD).

The selected goose meat quality traits in relation to various types of heat treatment.

The effect of water bath cooking (WBC), oven convection roasting (OCR), grilling (G), pan frying (PF) on selected physical properties of goose meat was compared in this study. A measurement of cooking loss, texture, color parameters, and sensory evaluation was carried out. The experimental material covered 96 breast muscles cut from carcasses of 17-week-old "Polish oat geese." The kind of goose meat (with and without skin) and the type of heat treatment affected cooking loss, shear force (SF), and rheological parameters (hardness, cohesiveness, gumminess, and chewiness). The water bath-cooked and pan-fried samples for both kinds of meat were characterized by lower cooking loss than other ones. Goose meat with skin and subcutaneous fat showed higher cooking loss and lower SF value, hardness, gumminess, and chewiness than that without skin for all methods. The water bath-cooked samples were characterized by the lowest SF value, hardness, and chewiness for both kinds of meat. They had the highest value of L∗ parameter and were characterized by a lighter color among others, too. Pan-fried meat showed the highest value of a∗ and lowest of ho parameters; the color of these samples was redder. Moreover, the lower C values of oven convection-roasted and grilled samples showed that they were brighter. According to the Comission Internationale de l'Eclairage classification, the ΔE parameter only for G and OCR indicated noticeable color differences (<2), whereas other pairs had visible differences. The method of cooking affected sensory descriptors such as the intensity of flavor and aroma, tenderness, juiciness, springiness, cohesiveness, and overall palatability of goose meat. The goose samples of PF, G, and OCR were characterized as very good and WBC as extremely desirable overall palatability. However, in the next stage of research, there is a need to study changes in the chemical composition, the degree of lipid oxidation, and the nutritional value of this meat that underwent different methods of cooking. Only then it will be possibly to clearly determine which method of the heat treatment of goose meat is optimal.

Inter-rater reliability in disability assessment based on a semi-structured interview report.

PURPOSE: To investigate whether physicians are able to perform a disability assessment based on a written report and to assess the inter-rater reliability between physicians in the assessment of work limitations. METHOD: In total, 12 insurance physicians used written reports to assess work limitations in 12 patients. The reports involved a semi-structured interview executed by a nurse practitioner. The insurance physicians were asked whether they could make reliable assessments based on these reports. In addition, inter-rater reliability was measured by computing their percentage agreement with respect to the mental and physical items of two Dutch disability lists (the Functional Information System and the Mental Ability List). RESULTS: The quality of the reports was evaluated as reasonable to good. Half the physicians found the assessment based on the reports to be reasonably reliable, 25% found the opposite and 25% was indecisive. The overall agreement between the insurance physicians was reasonable to good, with a mean agreement of 76% (range 64 - 88%). Agreement between the physicians concerning the number of hours a patient could function daily was low. CONCLUSIONS: Half the physicians thought that a reliable assessment based on the written information was possible. The quality of written patient reports made by nurse practitioners trained in conducting a semi-structured interview was considered reasonable to good by insurance physicians. The inter-rater reliability between insurance physicians of physical-disability and mental-disability assessment based on the written reports was reasonable to good. The assessment of the number hours patients could function daily had low inter-rater reliability.

Integrated care for MS patients.

PURPOSE: The problem of complex healthcare to MS patients, together with the rising prevalence of MS and escalating costs, has caused healthcare policy makers to consider innovative approaches to controlling costs and improving the quality of care. An integrated care approach may provide a means for better coordination and delivery of care. The aim is to review recent integrated care initiatives and their significance for MS patients. METHOD: A literature search was conducted to trace relevant literature on integrated care for MS patients published between 1995 and 2003. RESULTS: Although integrated care appears to offer potential for eliminating fragmentation and discontinuity in healthcare for MS patients, there are few published studies which have evaluated its implementation with MS patients. CONCLUSIONS: Even though the potential advantages of integrated care are well known, the applicability of this approach for MS patients has still to be demonstrated.

Effect of a kestose and nystose preparation on growth performance and gastrointestinal tract function of turkeys.

The aim of the present study was to determine the effects of dietary administration of a fructooligosaccharide preparation rich in kestose and nestose on growth performance and gastrointestinal parameters in young turkeys. The kestose and nestose preparation was obtained through bioconversion of sucrose using fungi fructosyl transferase and contained in DM 39.9% of kestose, 17.6% of nystose, as well as 26.5% of glucose and 14.7% of sucrose. Three dietary levels of the sum of kestose and nystose (0.3, 0.6, and 1.2%) were fed to growing turkeys for 8 wk. When compared with the control treatment, addition of the kestose and nestose preparation had no effect on feed intake, feed conversion, and BW. The kestose and nestose-supplemented diet, especially the medium level of kestose and nystose, influenced microbial metabolism, especially in the ceca. Compared with the control group, the medium level of kestose and nestose decreased relative weight of gizzard (from 18.67 to 16.51 g/kg of BW) and weight of small intestine tissue (from 23.3 to 19.6 g/kg of BW) and increased weight of ceca digesta (from 3.51 to 4.77 g/kg of BW) as well as activities of microbial beta-glucosidase (an increase from 0.22 to 0.38 U/g) and alpha-galactosidase (an increase from 0.90 to 1.61 U/g), pH of digesta (a decrease from 6.13 to 5.79), concentration of NH3 (an increase from 0.60 to 0.98 mg/g), and concentration of total short-chain fatty acids (an increase from 81.1 to 107.7 micromol/g) in the cecal digesta. A high content of kestose and nestose in the diet caused a decrease in ileal and cecal pH (to 5.42 and 5.49, respectively).

Barium concentration in cast roe deer antlers related to air pollution caused by burning of barium-enriched coals in southern Poland.

Concentrations of Ba, Zn, Pb, Fe, and Mn were determined by atomic absorption spectroscopy in freshly cast antlers from male roe deer of different ages (2 to 4 years old and older than 4 years) collected in Balin near Chrzanów and in the vicinity of Zywiec, S Poland. Barium content ranged from 124 to 196 ppm (mean 165 ppm) in the Balin 12 samples and from 207 to 351 ppm (mean 287 ppm) in 3 antlers from Zywiec. The concentration of Ba was comparable to that of Zn (134-275 ppm, mean 169 ppm). Elevated concentrations of Ba in antlers most probably originated from direct uptake of airborne barite nanocrystals through the respiratory system and/or by digestion of barite-rich dust particles deposited on plants. Burning of Ba-enriched coals is regarded as the principal source of Ba in the investigated areas inhabited by roe deer. Increased concentrations of Ba in antlers from the Zywiec area compared to Balin reflect particularly high air pollution caused by coal-burning mostly for domestic purposes combined with an unfavorable topography that impedes efficient air circulation.

Anthropogenic- and natural sources of dust in peatland during the Anthropocene.

As human impact have been increasing strongly over the last decades, it is crucial to distinguish human-induced dust sources from natural ones in order to define the boundary of a newly proposed epoch - the Anthropocene. Here, we track anthropogenic signatures and natural geochemical anomalies in the Mukhrino peatland, Western Siberia. Human activity was recorded there from cal AD 1958 (±6). Anthropogenic spheroidal aluminosilicates clearly identify the beginning of industrial development and are proposed as a new indicator of the Anthropocene. In cal AD 1963 (±5), greatly elevated dust deposition and an increase in REE serve to show that the geochemistry of elements in the peat can be evidence of nuclear weapon testing; such constituted an enormous force blowing soil dust into the atmosphere. Among the natural dust sources, minor signals of dryness and of the Tunguska cosmic body (TCB) impact were noted. The TCB impact was indirectly confirmed by an unusual occurrence of mullite in the peat.

Work-related determinants of return to work of employees on long-term sickness absence.

PURPOSE: The aim of the study is to identify work-related determinants of return to work (RTW) of employees who are on long-term sickness absence. METHOD: The study was based on a sample of 926 employees on sickness absence (maximum duration of 12 weeks). The employees filled out a baseline questionnaire and were subsequently followed until the 10th month after listing sick. Cox proportional hazards regression analyses were used to identify determinants of RTW. RESULTS: Working in one of the vocational sectors public administration, construction, financial and commercial services, transport, or education (P = 0.00) and having low co-worker support (P = 0.01) were related to longer duration to RTW in the multivariate model. Having low supervisor support (P = 0.01) was associated with a higher RTW rate. CONCLUSIONS: Vocational sector is a strong predictor of RTW. Especially employees from the sector education are slow as to RTW. The observed association between low supervisor support and RTW was unexpected. However, the study confirms earlier research on the association between low co-worker support and RTW.

Peatland Microbial Communities as Indicators of the Extreme Atmospheric Dust Deposition.

We investigated a peat profile from the Izery Mountains, located within the so-called Black Triangle, the border area of Poland, Czech Republic, and Germany. This peatland suffered from an extreme atmospheric pollution during the last 50 years, which created an exceptional natural experiment to examine the impact of pollution on peatland microbes. Testate amoebae (TA), Centropyxis aerophila and Phryganella acropodia, were distinguished as a proxy of atmospheric pollution caused by extensive brown coal combustion. We recorded a decline of mixotrophic TA and development of agglutinated taxa as a response for the extreme concentration of Al (30 g kg-1) and Cu (96 mg kg-1) as well as the extreme amount of fly ash particles determined by scanning electron microscopy (SEM) analysis, which were used by TA for shell construction. Titanium (5.9 %), aluminum (4.7 %), and chromium (4.2 %) significantly explained the highest percentage of the variance in TA data. Elements such as Al, Ti, Cr, Ni, and Cu were highly correlated (r > 0.7, p < 0.01) with pseudostome position/body size ratio and pseudostome position. Changes in the community structure, functional diversity, and mechanisms of shell construction were recognized as the indicators of dust pollution. We strengthen the importance of the TA as the bioindicators of the recent atmospheric pollution.

The expression of a functional, secreted human lysyl hydroxylase in a baculovirus system.

This study reports the expression of functional human lysyl hydroxylase (LH), a post-translational modifying enzyme that catalyzes the hydroxylation of the lysine residues essential for cross-linking in collagen biosynthesis. We have developed a novel baculovirus system for the expression of LH, a protein that exists normally within the lumen of the endoplasmic reticulum, using a powerful baculovirus signal sequence for secretion. The supernatant from Sf9 cells infected with the viral recombinant showed significant LH activity that increased linearly with supernatant concentration, whereas there was no detectable LH activity in the cell pellet. Silver staining of the fractions purified from the active supernatant by concanavalin A Sepharose chromatography and separated by sodium dodecylsulfate-polyacrylamide gel electrophoresis demonstrated an 85-kDa protein (the expected size of the LH subunit) that was most prominent in those fractions with the highest LH activity. N-terminal amino acid sequencing verified that the N-terminal primary structure of this 85-kDa protein was identical to human LH. Moreover, the activity of the expressed protein was shown to be dependent on the presence of Fe++, ascorbate, and alpha-ketoglutarate, three essential cofactors for LH activity. We have therefore successfully developed a novel expression system that produces functional human LH and enables this normally nonsecretory enzyme to be secreted, facilitating its separation from the intracellular proteins of insect cells. Future applications should allow characterization of the LH active site by crystallographic studies and site-directed mutagenesis for structure-function comparison.

General practitioners' characteristics and the assessment of psychiatric illness.

We put forward the hypothesis that general practitioners (GPs) with a family medicine orientation are more sensitive to the presence of mental health problems than GPs with a clinical orientation. To test it, GPs were divided into three subgroups on the basis of an attitude questionnaire. The General Health Questionnaire (GHQ) and the Present State Examination (PSE) were used as criteria. No differences in sensitivity to psychiatric illness were observed using either scale. Results of factor analysis with the subscales of the GP attitude questionnaire and the indices 'bias' and 'accuracy' were similar to those reported by GOLDBERG and associates. 'New' patients were defined as patients in whom the GP had not identified a mental health problem (MHP) in the past year. 'Old' patients were defined as 'not new'. GPs tended to under-identify MHPs in 'new' and over-identify them in 'old' patients. Recognition of psychiatric illness was better in 'old' than in 'new' patients. In 'new' patients, recognition depended on psychiatric diagnosis. Among 'old' patients, older people and people (especially women) with low education predominated. In their assessments GPs used information not contained in the GHQ.

Social support, social disability, and psychological well-being in rheumatoid arthritis.

PURPOSE: Rheumatoid arthritis (RA) is a disease that may lead to social disability. As a consequence, the psychological well-being of RA patients can be strained. Social support is a possible moderator of the relation between social disability and psychological well-being. The focus of the present study is on the main effect versus the buffering effect of social support. METHODS: Data on 54 RA patients were gathered by means of a 2-hr interview at the patient's home. RESULTS: Receiving more daily emotional support positively related to greater psychological well-being; whereas problem-oriented emotional support negatively related to some aspects of psychological well-being. People receiving more social companionship turned out to be less depressed. CONCLUSION: The assumption was confirmed that social support has a major effect on psychological well-being. A buffering effect of social support was not demonstrated.

The measurement of social support in the 'European Research on Incapacitating Diseases and Social Support': the development of the Social Support Questionnaire for Transactions (SSQT).

Social support is supposed to have a beneficial effect on the health and wellbeing of people. It is a central concept in the 'EUropean Research on Incapacitating DIseases and Social Support' (EURIDISS). In general, two main distinctions concerning social support are made in the literature, providing four basic dimensions or types of social support: a social-emotional vs an instrumental type of social support, and a 'crisis' or 'problem-oriented' vs 'everyday' or 'daily' type of social support. Based on these types of social support, a series of items were formulated to measure actual supportive interactions or exchanges of resources. The items were spread over five scales. The social-emotional type of social support comprised three scales: daily emotional support; problem-oriented emotional support; and social companionship, while the instrumental type of social support consisted of two scales: the daily instrumental support and the problem-oriented instrumental support. Together, these items and scales constitute the so-called 'Social Support Questionnaire for Transactions' (SSQT). The main objective of this paper is to investigate whether one and the same instrument, i.e. the SSQT, allows for meaningful comparisons between patients with rheumatoid arthritis from different countries. More specifically, the dimensionality and invariance of the dimensions across countries of the SSQT are explored. To this end, patients from four different European countries (France, Norway, The Netherlands and Sweden) were asked to fill in the SSQT. The analysis of the data using principal component analysis (PCA) and simultaneous component analysis (SCA), did yield the intended scales, although the internal consistency of one of them, the daily instrumental support scale, is questionable.(ABSTRACT TRUNCATED AT 250 WORDS)

An international study on measuring social support: interactions and satisfaction.

Recently, a new instrument was developed to measure social support. It consists of two parts; the Social Support Questionnaire for Transactions (SSQT) and the Social Support Questionnaire for Satisfaction with the supportive transactions (SSQS). The SSQT measures the number of supportive interactions and has proved to have good psychometric properties. From the taxonomy that was used for the present study, it results that social support in general consists of two aspects. There are, on the one hand, actual supportive transactions and, on the other hand, the perception of being supported or the satisfaction with the social support provided. In the present study, two research questions were addressed. The first concerned the psychometric properties of the SSQS, measuring the individual's satisfaction with the supportive interactions provided. Secondly, the relative contribution of both supportive interactions (the SSQT) and the satisfaction with the support provided (the SSQS) were assessed, in explaining the level of health related quality of life outcome. The data of 744 rheumatoid arthritis (RA) patients from four different countries (116 French, 238 Norwegian, 98 Swedish and 292 Dutch patients) were used in the present study. At the entry of the study, all patients fulfilled four out of seven American Rheumatism Association (ARA) criteria and had a disease duration of 4 years or less. The results of the study indicate that the SSQS has good psychometric properties across countries. Cronbach's alpha for the emotional support scales was 0.80 or more, and for the instrumental support subscales around 0.60. The standardized regression coefficients demonstrated that, compared to supportive interactions, support satisfaction was more relevant in explaining health related quality of life measures, although it is recommended that the SSQT and SSQS be used to complement each other.

Cadmium-induced changes in the histoenzymatic activity in liver, kidney and duodenum of pregnant rats.

Cadmium was administered in drinking water at a concentration of 50 ppm to female Wistar rats for 5 months before mating, and then continued during gestation. The histochemical evaluation revealed a relative decrease in succinic dehydrogenase (SDH) and Mg+2-stimulated ATPase activities in duodenum, liver and kidney in the exposed rats. It is suggested that the resulting decrease in metabolic efficiency in maternal organs would be expected to exert an indirect, inhibitive effect on maternal-fetal transfer of nutrients, as reflected by fetal growth retardation.

Social support, rheumatoid arthritis and quality of life: concepts, measurement and research.

In recent years, medical technology has improved considerably and the possibilities to replace destroyed parts of the body that have been affected by rheumatoid arthritis (RA), have grown also. However, the availability and application of advanced techniques does not automatically entail an improvement of quality of life of individuals. Although the physical (dis)ability of RA patients very often leads to certain restrictions, it is not the only element in the evaluation of life-as-a-whole. The way in which the RA-patient copes with the uncertainty of tomorrow and the management of pain and fatigue is another important element in evaluating quality of life. Beside personality factors, social network and social support are regarded to play an important role in this respect and subsequently in the well-being of individuals in general, and especially where it concerns individuals suffering from a chronic disease. Today, a growing number of evidence of the beneficial impact of social support is available some of which are discussed.

Medical, physical and psychological status related to early rheumatoid arthritis.

As part of an international European research project, a longitudinal study was started by the end of 1990 in the northern part of The Netherlands. The study concentrated on recently diagnosed RA patients (N = 292), i.e., incident cases up to four years. According to the duration of the disease, five groups of patients had been formed. The early influence of rheumatoid arthritis on medical parameters, on functional status, on physical condition and on psychological well-being was evaluated. From the results, an overall statistically significant pattern related to the duration of the disease could not be distinguished. However, patients recently diagnosed did face activity restrictions, a decline in physical condition and social functioning. On medical parameters this deterioration is less profound. Furthermore, across and within the five patient groups, it seems that males and females respond differently to the influence of early RA. Based on cross-sectional data from the five onset cohorts, the present findings do not significantly suggest a steady worsening in medical, physical and psychological condition.

Factors related to outcome of salvage therapy for isolated cervical recurrence of squamous cell carcinoma in the previously treated neck: a multi-institutional study.

OBJECTIVE: The goal was to identify factors associated with the outcome of salvage therapy for patients with isolated cervical recurrences of squamous cell carcinoma in the previously treated neck (ICR-PTN). STUDY DESIGN AND SETTINGS: A tumor registry search for ICR-PTN patients was performed at 7 participating institutions, and the charts were reviewed. Kaplan-Meier plots for survival and time until re-recurrence were used to evaluate the significance of associated variables. RESULTS: Median survival and time until re-recurrence were both 11 months. Survival was better in patients with the following characteristics: nonsurgical initial neck treatment, negative initial disease resection margins, no history of prior recurrence, ipsilateral location of the ICR-PTN relative to the primary, and use of surgical salvage. CONCLUSIONS: By pooling the experience of 7 US tertiary care medical centers, we have identified 5 factors that are associated with outcome of salvage therapy for ICR-PTN. SIGNIFICANCE: Consideration of these factors, as well as the reviewed literature, should facilitate patient selection for salvage protocols.

Effect of citric acid, citrate and slight a(w) decreases on the bacteriological stability of Hague liver sausage.

Combinations of citric acid and citrate, with several carbohydrates and KCl, were tested in a canned Hague liver sausage model for their antimicrobial properties. pH values for the test products ranged from 5·38 to 6·48; a(w) values varied from 0·960 to 0·977. Before pasteurization, the sausage doughs were contaminated with mixtures of bacterial spores. Since the bacteriological stability sometimes appeared to be considerably improved, heated packages were challenged by incubation at 20° and 30°C; some of them for up to 2 years. Incubated packages from the standard formulation spoiled at 30°C within 3 days. Starting from this point, products with a variable, but increased, bacteriological stability were obtained. For the best stabilized batches, first symptoms of spoilage were observed after periods of incubation at 30°C, ranging from 49 to 150 days. Combinations of pH and a(w) values which can be relied upon to yield stable products consistently, cannot be derived from the accumulated data. Citric acid appeared a far more effective stabilizer than its salt. If we regard the undissociated citric acid concentration for these products (a(w) 0·960-0·972) as a significant parameter, values above approximately 13 µmkg(-1), yielded products with remarkable bacteriological stability.