Extended approach or usage of nasoseptal flap is a risk factor for olfactory dysfunction after endoscopic anterior skullbase surgery: results from 928 patients in a single tertiary center.

BACKGROUND: The aim of this study was to compare olfactory function change in patients who underwent endoscopic skull-base surgery. METHODOLOGY: A total of 928 patients were included in this retrospective study. Olfactory function was measured using the non- validated Likert scale (0â€"100), the Cross-Cultural Smell Identification Test (CC-SIT) and the butanol threshold test (BTT). Patients were divided into two groups: an endoscopic trans-sellar approach group (ETA, n = 768) and an extended endoscopic endonasal approach group (EEEA, n = 160). The ETA group was sub-divided into Nasoseptal flap (NSF) and no NSF groups. RESULTS: Non-validated olfactory function significantly worsened in the EEEA and ETA-NSF groups compared with that in the ETA- no NSF group for at least 6 months post-operatively. Validated olfactory impairment (BTT and CC-SIT) was also significantly worse in the EEEA and NSF groups compared with that in the ETA-no NSF group 3 months post-operatively. Additionally, the degrees of non-validated and validated olfactory deterioration were not significantly different between the EEEA and ETA-NSF groups. We also found that CC-SIT score changes were significantly impaired in tuberculum sellae meningioma patients than in craniopharyn- gioma patients. CONCLUSIONS: We conclude that NSF was the key factor that led to olfactory impairment after endoscopic skull-base surgery.

Predictive capabilities of serum eosinophil cationic protein, percentage of eosinophils and total immunoglobulin E in allergic rhinitis without bronchial asthma.

This study identified cut-off values for allergy markers for use in the diagnosis of allergic rhinitis in the absence of other allergic diseases. Total immunoglobulin E (IgE), eosinophil cationic protein (ECP) and the numbers of eosinophils were measured in serum samples from 442 patients with typical symptoms of allergic rhinitis. A definite diagnosis was made on the basis of the presence of specific IgE levels. Cut-off values with a maximal discrimination to diagnose allergic rhinitis were found to be 98.7 IU/ml, 24.7 µg/ml and 4.0% for total IgE, ECP and eosinophils, respectively. Sensitivity, specificity and odds ratio for these values were 75.2%, 69.7% and 6.93, respectively, for total IgE, 55.7%, 74.4% and 3.70 for ECP, and 57.5%, 72.0% and 3.47 for eosinophils. A composite score representing positive results for all three markers had a positive predictive value of 85.3%, with an odds ratio of 8.55. It was concluded that total serum IgE, ECP and eosinophil percentage are strong predictors of allergic rhinitis and the determination of cut-off values for these markers can aid in the diagnosis of allergic rhinitis in the clinical setting.

Lifetime-limiting strength degradation from contact fatigue in dental ceramics.

The hypothesis under examination in this paper is that the lifetimes of dental restorations are limited by the accumulation of contact damage during oral function; and, moreover, that strengths of dental ceramics are significantly lower after multi-cycle loading than after single-cycle loading. Accordingly, indentation damage and associated strength degradation from multi-cycle contacts with spherical indenters in water are evaluated in four dental ceramics: "aesthetic" ceramics-porcelain and micaceous glass-ceramic (MGC), and "structural" ceramics-glass-infiltrated alumina and yttria-stabilized tetragonal zirconia polycrystal (Y-TZP). At large numbers of contact cycles, all materials show an abrupt transition in damage mode, consisting of strongly enhanced damage inside the contact area and attendant initiation of radial cracks outside. This transition in damage mode is not observed in comparative static loading tests, attesting to a strong mechanical component in the fatigue mechanism. Radial cracks, once formed, lead to rapid degradation in strength properties, signaling the end of the useful lifetime of the material. Strength degradation from multi-cycle contacts is examined in the test materials, after indentation at loads from 200 to 3000 N up to 10(6) cycles. Degradation occurs in the porcelain and MGC after approximately 10(4) cycles at loads as low as 200 N; comparable degradation in the alumina and Y-TZP requires loads higher than 500 N, well above the clinically significant range.

Regeneration of nerve fibres in the maxillary sinus mucosa after experimental surgery. An immunocytochemical double-labelling study in the rabbit.

Nerve fibre regeneration in the maxillary sinus mucosa after surgery was studied in 10 New Zealand White rabbits. Four and 8 weeks following unilateral removal of the mucosa, the animals were fixed by perfusion, and the nose-sinus complexes were frozen and cut on a cryostat equipped with a tungsten-hardened knife. A double-labelling immunocytochemical procedure was developed with commercially available antibodies to protein gene product (PGP) 9.5 and tyrosine hydroxylase (TH) or neuropeptide Y (NPY). The study revealed that the maxillary sinus mucosa in rabbit is reinnervated at 4 and 8 weeks postoperatively. Furthermore, the regenerated lamina propria showed increased TH immunoreactivity (TH-IR) and NPY-IR, compared with the contralateral, non-operated side. Many of the fibres were seen in close proximity to newly formed vessels. These findings add further to the explanation of the altered vasoreactivity found earlier in regenerated sinus mucosa 1 month after surgery. This study also showed that demineralization of the nose-sinus complexes is not necessary if a hardened metal knife is used.

Damage modes in dental layer structures.

Natural teeth (enamel/dentin) and most restorations are essentially layered structures. This study examines the hypothesis that coating thickness and coating/substrate mismatch are key factors in the determination of contact-induced damage in clinically relevant bilayer composites. Accordingly, we study crack patterns in two model "coating/substrate" bilayer systems conceived to simulate crown and tooth structures, at opposite extremes of elastic/plastic mismatch: porcelain on glass-infiltrated alumina ("soft/hard"); and glass-ceramic on resin composite ("hard/soft"). Hertzian contacts are used to investigate the evolution of fracture damage in the coating layers, as functions of contact load and coating thickness. The crack patterns differ radically in the two bilayer systems: In the porcelain coatings, cone cracks initiate at the coating top surface; in the glass-ceramic coatings, cone cracks again initiate at the top surface, but additional, upward-extending transverse cracks initiate at the internal coating/substrate interface, with the latter dominant. The substrate is thereby shown to have a profound influence on the damage evolution to ultimate failure in the bilayer systems. However, the cracks are highly stabilized in both systems, with wide ranges between the loads to initiate first cracking and to cause final failure, implying damage-tolerant structures. Finite element modeling is used to evaluate the tensile stresses responsible for the different crack types. The clinical relevance of these observations is considered.

Contact damage resistance and strength degradation of glass-infiltrated alumina and spinel ceramics.

All-ceramic crowns are coming into widespread use because of their superior esthetics and chemical inertness. This study examines the hypothesis that glass-infiltrated alumina and spinel core ceramics are resistant to damage accumulation and strength degradation under representative oral contact conditions. Accordingly, Hertzian indentation testing with hard spheres is used to evaluate damage accumulation in alumina and spinel ceramics with different pre-form grain morphologies and porosities. Indentation stress-strain curves measured on fully infiltrated materials reveal a marked insensitivity to the starting pre-form state. The glass phase is shown to play a vital role in providing mechanical rigidity and strength to the ceramic structures. All the infiltrated ceramics show subsurface cone fracture and quasi-plastic deformation above critical loads P(C) (cracking) and P(Y) (yield), depending on sphere radius, with P(Y) < P(C). Strength degradation from accumulation of damage in Hertzian contacts above these critical loads is conspicuously small, suggesting that the infiltrated materials should be highly damage-tolerant to the "blunt" contacts encountered during mastication. Failure in the strength tests originates from either cone cracks ("brittle mode") or yield zones ("quasi-plastic mode"), with the brittle mode more dominant in the spinels and the quasi-plastic mode more dominant in the aluminas. Multi-cycle contacts at lower loads, but still above loads typical of oral function, are found to be innocuous up to 10(5) cycles in air and water, although contacts at 10(6) cycles in water do cause significant strength degradation. By contrast, contacts with Vickers indenters produce substantial strength losses at low loads, suggesting that the mechanical integrity of these materials may be compromised by inadvertent "sharp" contacts.

Amino acid metabolism of bovine blastocysts derived from parthenogenetically activated or in vitro fertilized oocytes.

The uptake and synthesis of 19 amino acids by fresh or frozen-thawed bovine blastocysts produced by parthenogenesis (PT) or in vitro fertilization (IVF) were compared in the present study. Fresh blastocysts, 180 h after IVF or PT activation, and frozen-thawed blastocysts, 168 h old and cultured for 12 h post-thawing, were cultured in synthetic oviduct fluid medium (SOFM) containing polyvinyl alcohol (PVA) with both essential and non-essential amino acids (EAA and NEAA, respectively) (Medium 1: M1) or SOFM containing PVA with only EAA (Medium 2: M2). In Experiment 1, when fresh or frozen-thawed PT blastocysts were cultured in M1, the uptake of glutamate (in fresh only), aspartate and arginine, and the synthesis of glutamine and alanine were significantly enhanced. In the culture with M2, serine, asparagine, glutamate, glutamine, glycine, arginine and alanine were significantly taken up. It was found that the glutamine concentrations was significantly higher (P < 0.001) in the culture medium drops containing embryos than in the drops without embryos. In Experiment 2, when PT blastocysts were cultured in M1, the uptake of aspartate and synthesis of alanine were greater (P < 0.01) than those by IVF blastocysts. When M2 was used, a significant (P < 0.01) production of serine, asparagine, glutamate, glutamine and alanine, and the uptake of arginine by PT blastocysts were observed. In Experiment 3, when IVF blastocysts were cultured in M1, fresh blastocysts depleted more aspartate and glutamate, and produced more glutamine and alanine than frozen-thawed blastocysts. When cultured in M2, frozen-thawed blastocysts depleted more threonine (P < 0.01) than fresh blastocysts. These results indicate that the uptake and synthesis of amino acids were different in fresh or frozen-thawed bovine blastocysts derived from PT or IVF. These differences in amino acid metabolism may be related to the viability of the blastocysts.