There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality.

Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

I and i

I. Executive summary BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. Methods ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. Conclusion This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Objective: As the clinical implications of Helicobacter pylori infection in children and adolescents continue to evolve, ESPGHAN and NASPGHAN jointly renewed clinical guidelines using a standardized evidence-based approach to develop updated recommendations for children and adolescents in North America and Europe. Methods: An international panel of 11 pediatric gastroenterologists, 2 epidemiologists, 1 microbiologist, and 1 pathologist was selected by societies that developed evidence-based guidelines based on the Delphi process with anonymous voting in a final face-to-face meeting. A systematic literature search was performed on 8 databases of relevance including publications from January 2000 to December 2009. After excluding nonrelevant publications, tables of evidence were constructed for different focus areas according to the Oxford classification. Statements and recommendations were formulated in the following areas: whom to test, how to test, whom to treat, and how to treat. Grades of evidence were assigned to each recommendation based on the GRADE system. Results: A total of 2290 publications were identified, from which 738 were finally reviewed. A total of 21 recommendations were generated, and an algorithm was proposed by the joint committee providing evidence-based guidelines on the diagnostic workup and treatment of children with H pylori infection. Conclusions: These clinical practice guidelines represent updated, bestavailable evidence and are meant for children and adolescents living in Europe and North America, but they may not apply to those living on other continents, particularly in developing countries with a high H pylori infection rate and limited health care resources.

/pdf/evidence-based-guidelines-from-espghan-and-naspghan-for-35ku3kivll.pdf

Evidence-based Guidelines From ESPGHAN and NASPGHAN for Helicobacter pylori Infection in Children

Background The apelin system is a novel peptidic pathway widely expressed in the
heart and vasculature. In preclinical studies, apelin receptor agonism mediates
nitric oxide-dependent vasodilatation, reduces ventricular preload and afterload and
potently increases myocardial contractility. In preclinical models of heart failure,
expression of the apelin pathway is down regulated but the haemodynamic effects of
apelin receptor agonism are preserved. These changes in expression appear to be
paralleled in patients with chronic heart failure but the cardiovascular actions of
apelin in vivo in man are, to date, unknown. Detailed clinical investigation is
therefore required to establish the role of apelin in human cardiovascular physiology
and pathophysiology and to explore the therapeutic potential of apelin receptor
agonism in patients with heart failure.
Objectives Through a series of in vivo clinical studies: 1) to establish the direct
vascular actions of apelin in the peripheral venous, peripheral arterial and coronary
arterial circulations; 2) to determine the contribution of the endothelium-derived
vasodilators, nitric oxide and prostacyclin, to the vascular actions of apelin; 3) to
establish the effects of apelin on cardiac contractility and systemic haemodynamics;
4) to compare the direct vascular and systemic haemodynamic effects of the fulllength
mature apelin peptide, apelin-36, with a shorter, biologically active carboxyl
(C)-terminal fragment, (Pyr1)apelin-13); and 5) to establish whether the local
vascular and systemic haemodynamic effects of apelin are altered in patients with
chronic heart failure.
Methods The cardiovascular effects of apelin were assessed in 32 healthy
volunteers, 6 patients undergoing elective diagnostic coronary angiography,
18 patients with stable New York Heart Association (NYHA) class II-III chronic
heart failure and 18 age- and sex-matched healthy controls. Dorsal hand vein tone
was assessed by the Aellig hand vein technique during local intravenous
infusions (0.1-3 nmol/min) of apelin-36, (Pyr1)apelin-13, and sodium nitroprusside
(SNP; 0.6 nmol/min). Forearm blood flow was measured by venous occlusion
plethysmography during intrabrachial infusions of apelin-36 and (Pyr1)apelin-13
(0.01-30 nmol/min) and subsequently in the presence or absence of a ‘nitric oxide
clamp’ (nitric oxide synthase inhibitor, L-NG-monomethylarginine (L-NMMA;
8 μmol/min), co-infused with SNP (90-900 ng/min)), or a single oral dose of aspirin
(600 mg) or matched placebo. Coronary blood flow was evaluated by quantitative
coronary angiography (QCA) and Doppler flow wire, and left ventricular pressures
measured by pressure wire before and after intracoronary injection of apelin-36
(20 and 200 nM), 0.9% saline and glyceryl trinitrate (GTN) (100 μg). Blood
pressure, heart rate, cardiac output and peripheral vascular resistance were assessed
by sphygmomanometry and thoracic electrical bioimpedance (TEB) during systemic
intravenous infusion of apelin-36 and (Pyr1)apelin-13 (30-300 nmol/min). Forearm
blood flow and systemic haemodynamic responses to (Pyr1)apelin-13 in patients with
chronic heart failure were then compared with age- and sex-matched healthy
controls.
Results Although SNP caused venodilatation (P<0.0001), apelin-36 and
(Pyr1)apelin-13 had no effect on dorsal hand vein diameter (P=0.2). Both apelin
isoforms caused vasodilatation in forearm resistance vessels (P<0.0001) but the
offset was slower with apelin-36. (Pyr1)apelin-13-mediated vasodilatation was
attenuated by the nitric oxide clamp (P=0.004) but unaffected by aspirin (P=0.7).
Intracoronary bolus of apelin-36 increased coronary blood flow and the maximum
rate of rise in left ventricular pressure, and reduced peak and end-diastolic left
ventricular pressures (all P<0.05). Both (Pyr1)apelin-13 and apelin-36 increased
heart rate and cardiac output whilst reducing peripheral vascular resistance (P<0.01
for all) with no overall effect on blood pressure. Intrabrachial infusions of
(Pyr1)apelin-13, acetylcholine and SNP caused forearm vasodilatation in patients and
controls (P<0.0001 for all). Vasodilatation to acetylcholine (P=0.01) but not apelin
(P=0.3) or SNP (p=0.9) was attenuated in patients with heart failure. Systemic
infusions of (Pyr1)apelin-13 increased cardiac index and lowered mean arterial
pressure and peripheral vascular resistance index in patients and matched controls
(all P<0.01) but increased heart rate only in controls (P<0.01).
Conclusions Although having no apparent effect on venous tone, acute apelin
receptor agonism causes peripheral and coronary vasodilatation and increases cardiac
contractility and output. Local vascular and systemic haemodynamic responses to
apelin are preserved in patients with stable symptomatic chronic heart failure. The
apelin system merits further clinical investigation to determine its role in
cardiovascular homeostasis and represents a novel potential therapeutic target for
patients with heart failure.

Cardiovascular effects of apelin in vivo in man

As we enter the Post-Human age many of our beliefs become redundant—not least the belief in human being.

What is a Human

The effects of tonsillectomy and adenoidectomy on pulmonary arterial pressure in children

Does Helicobacter pylori have role in development of otitis media with effusion

Objective: Obstructive adenoid and tonsillar hyperplasia may present with retardation of growth. Interruption of growth hormone-insulin-like growth factor I axis resulting from abnormal nocturnal growth hormone secretion is among the postulated causes. Growth hormone (GH) mediates its anabolic effects on tissues through insulin-like growth factor I (IGF-I). Most of the circulating IGF-I is bound to insulin-like growth factor binding protein 3 (IGFBP3). The objective of this study is to determine blood serum levels of IGF-I and IGFBP3 in patients with adenoid and tonsillar hypertrophy. Furthermore, we want to investigate the effect of tonsillectomy and adenoidectomy (T&A) on these levels. Study Design: The blood serum levels of IGF-I and its binding protein IGFBP3 were examined in 41 randomly selected children with a diagnosis of upper airway obstruction resulting from hypertrophic tonsils and adenoids. Methods: Blood samples were taken preoperatively and repeated at 3 to 6 months (mean, 4.3 mo) following T&A operation. Coated-tube immunoradiometric assay (IRMA) method was used to analyze IGF-I and IGFBP3 levels. Results: Thirty-two of 41 children were eligible for the analysis. When the preoperative and postoperative results were compared, it was found that there was a statistically significant increase in serum IGF-I and IGFBP3 levels in these 32 children (P <.001). In 7 of the 32 patients, the preoperative serum IGF-I levels were below normal. Postoperatively these levels increased within normal range. This was also statistically significant (P .016). Conclusion: These findings revealed that obstructive adenoid and tonsillar hypertrophy may cause decreased serum IGF-I levels by affecting the GH-IGF-I axis, and T&A is an effective therapeutic measure in these patients. Key Words: Tonsil hypertrophy, T&A, IGF-I, growth hormone, growth retardation. Laryngoscope, 112:922–925, 2002

The effects of tonsillectomy and adenoidectomy on serum IGF-I and IGFBP3 levels in children.

OBJECTIVES 
The purpose of the present investigation is to examine whether induced hypotension with propofol or sevoflurane anesthesia improves the dryness of surgical field in endoscopic sinus surgery (ESS)
 METHODS 
The study was performed between 1999 and 2002 in Celal Bayar University and Afyon Kocatepe University Hospitals, Turkey Thirty-two patients (American Society of Anesthesiologists physical status I and III) with chronic sinusitis undergoing outpatient endoscopic sinus surgery under general anesthesia were studied to determine if anesthetic technique had an impact on estimated blood loss The patients were allocated randomly into 2 groups None of the patients were premedicated Anesthesia was induced with propofol in both groups and maintained with propofol/fentanyl in the first group and sevoflurane/fentanyl in the second group In both groups, controlled hypotension was used to improve surgical condition
 RESULTS 
There were no differences between the duration of surgery and intraoperative mean arterial blood pressure when comparing the 2 groups The average estimated blood loss in the propofol group was 1281 +/- 373 ml compared with an average estimated blood loss of 2969 +/- 978 ml in the sevoflurane group (p<001)
 CONCLUSIONS 
General anesthesia based on propofol infusion may have the advantage of decreased bleeding compared with conventional inhalation agents Therefore, making endoscopic surgery technically easier and safer by improving endoscopic visualization of the surgical field

Mustafa Deniz Yilmaz

Papers

The effects of tonsillectomy and adenoidectomy on pulmonary arterial pressure in children

Does Helicobacter pylori have role in development of otitis media with effusion

The effects of tonsillectomy and adenoidectomy on serum IGF-I and IGFBP3 levels in children.

Comparison of propofol and sevoflurane anesthesia by means of blood loss during endoscopic sinus surgery.

Characteristics of lacrimo-auriculo-dento-digital (LADD) syndrome: case report of a family and literature review.