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This page lists all of the BLAST related tools/programs available from NCBI. For this exercise click on the link to the Standard protein-protein BLAST [blastp]. Please look over the page to become familiar with the information available and the data required for a search. 2. There are quite a few links on this page to information about BLAST and to explanations of the data required or the program settings. These links are a good resource and should be reviewed. 3. Paste the following FASTA format of the sequence into the large data entry field. >unknown protein
Interpreting Results 1. The BLAST results page begins with the program version used, the reference for BLAST, the name and length of the query sequence, the database searched, and contact information. It is best to pay attention to this information so you will know that the proper query, database and program were run. 2. Next can be found the number of hits on the query sequence (i.e. the number of sequences in the database that have some similarity to the query sequence) and a graphical overview of the alignment of the hits to the query. 3. The long red line near the top of the graphical overview represents the length of the query sequence. Each hit from the database is represented by a line below the query that is colored to represent its score. The multicolored bar at the top of the graphical overview is a legend with the different colors representing different similarity score ranges. Red is used for hits with a score over 200 (good similarity) and so on. 4. The graphical overview shows the relative position of similar regions in each hit and the query and how big these regions of similarity are. Moving the mouse cursor over each hit line will bring up that hit sequences name in the text box above the graphic. 5. The graphical overview can be a very useful preliminary tool in the game to help determine if the sample (query) sequence is of terrestrial origin or not. However, do not make your determination only with this section of the results. If the query has hits that show up as long similar regions and are red and/or pink, it is probable that the query is terrestrial. If the query has hits that are short and black or blue, it is possible that the query is extra-terrestrial. If the query has short red or pink hits or hits that are in the middle of the range, more analysis than BLAST will need to be done to make an origin determination. 6. The next two sections of the results are more important, they show scoring and pairwise alignments. The section below the graphical overview ranks the hits by score. For each hit it gives a link by the accession number to the hit sequence in the database, the name of the hit sequence, the BLAST score, and the Expect value or E-value. The E-value is a statistical calculation based on the score that gives the number of hits of this score that this search would return by chance using a database of this size. I.e. If the E-value is 1, it is likely that you would get one chance hit with this score to the query using the particular database that was searched. The following general conclusions can be drawn from the E-values: If the E-value is less than 1 X 10-50 ,the hit is very similar to the query sequence and is very likely to be evolutionarily related. If E-values in this range are obtained, the sequence can be assumed to be terrestrial contamination, especially if the names/descriptions of many of the top hits indicate that the hits are related to each other. However, at the higher game levels when more tools are available for use, the sample sequence should be analyzed with all tools to show corroborating evidence for the conclusion. If the E-value is between 1 X 10-50 and 1 X 10-2, the hit has some similarity to the query sequence and may be related. When E-values in this range are obtained, the game sequence may be found to be terrestrial contamination, but further analysis will be needed. These values can indicate that the sample sequence is in the same family as the hit or it may have closely related functional domains. If the top hits all 1
4. The boxes immediately below the sequence entry box allow the selection of only a part of the entered sequence as the query for the search. For the purposes of this game, nothing should be entered in these fields. 5. The next field is a drop menu that allows the selection of the database to be searched. The non-redundant database (nr) is the default setting, but the new entries for the last month, EST's, a specific organism, or many others may also be selected. Leave the choice as nr for the game because it is the largest and most comprehensive database for BLAST to search. 6. The next check box allows the search of a conserved domains database. You may leave this checked, but the game will not use this function. Domain searches will be performed using BLOCKS and ProfileScan. 7. For basic searches, the only other option that should be changed is the filtering. Uncheck the box under the next section (Options) next to the words 'Choose filter.' For game purposes, the sequences should not normally be filtered. For information on situations when this box should be checked (only sometimes in levels 3 and 4), see the "More Advanced Information" section below. 8. Click on the "BLAST!" button to run the blastp search. 9. A new page will appear with the ID number of the search and the approximate wait time. Click on the "Format!" button and wait. The results will be returned when the search is complete.
seem to be related, this makes it more likely that the query is of the same family/type. If the E-value is between 1 X 10-2 and 1, the hit has a slight possibility of being related to the query. This may indicate a distant evolutionary relationship. In order to conclude that the query sequence was either terrestrial or extra-terrestrial, much more analysis would be required. If the E-value is above 1, the hit is not very closely related to any sequence in the database. If E-values in this range are obtained in the game, it can be concluded that the sample sequence is very possibly of extra-terrestrial origin. This conclusion can also be made when no matches are found at all. 7. For the search performed in this tutorial, the results give a top hit with an E-value of 1 X 10-132 which is an exact match to the query sequence. Sometimes exact and closely matched hits will have E-values of 0. 8. The last large section of the results, gives a pairwise alignment of the query sequence and similar regions in each hit. After the database accession number and name of the hit sequence, this section gives the score, E-value, percentage of bases or nucleotides that are identical and for proteins the percentage that are chemically similar (positives). The section is useful in determining if the query has an exact match in the database. If the percent identity of the first hit and the query sequence is 100% then the game sample sequence is in the database and the sample is definitely terrestrial contamination. 9. The very end of the result report gives information on the scoring matrix and gap penalties used, the number of sequences queried in the database and so on. 10. The query run for this tutorial results in a large number of full length and near full length red and pink hits shown in the graphical overview. The pairwise alignment with the top scoring hit shows a 100% identity with the query sequence. This leads to the conclusion that the query sequence is a Bacillus cereus beta-lactamase present in the nr database. If these results were obtained in the game, terrestrial contamination would be evident.
Interpreting Results 1. For the more complicated game problems presented in level 4, the length of BLAST hits becomes much more important. If the query sequence is short (less than 100 nucleotides or amino acids long), the top E-values may be larger than 1 X 10-50 even if there is an exact match. Be sure and check the % identity of the top hits, not just the E-values. Hits with low E-values that only have similarity to short regions of the query sequence are more likely to indicate that the sequences have motif or functional domain similarities rather than that they represent related genes or proteins. This is very likely the case when all of the matches are from sequences whose names and descriptions do not seem to indicate that the hits are in any way related to each other. Hits with higher E-values, in the ranges of 1 X 10-50 to 1 X 10-5, may still indicate that the query and hits are related if the hit has at least a 35% identity with the query over at least 80% of its length. Another indication of this is if several hits have names and/or descriptions that indicate that they are related to each other. These should definitely be studied further. 2. Always look at the names/descriptions of the hits returned by BLAST. The higher the percentage of hits that seem to be related to each other, the more likely it is that the query is also related to them. But remember, if the similarity is only in small regions, this is more likely to indicate related functional domains rather than related proteins/gene products. If only a small region of a protein has some similarity to a few sequences in the database, it is a possibility that this resulted from convergent evolution (unrelated sequences evolving similar structures for similar functions) and the query might still be extra-terrestrial. This type of BLAST result would require much more study before any conclusion could be reached. 3. The blastn search performed on the sequence above results in some hits with mid-range E-values and the rest with higher ones. The top hits have over 80% identity to more that 80% of the length of the query sequence. And, all of the top matches are cat cytochrome b sequences, with many of the remaining matches coming from cytochrome b sequences of other mammalian species. Even though there is no exact match in the database, these results indicate that the sample sequence is almost surely terrestrial. Other available tools should be used to analyse the sequence to build a body of supporting evidence for this conclusion. The five flavors of BLAST perform the following tasks: blastp compares an amino acid query sequence against a protein sequence database; blastn compares a nucleotide query sequence against a nucleotide sequence database; blastx compares the six-frame conceptual translation products of a nucleotide query sequence (both strands) against a protein sequence database; tblastn compares a protein query sequence against a nucleotide sequence database dynamically translated in all six reading frames (both strands).
More Advanced Information The information in this section is separated so as not to confuse the beginner, but will be useful and even necessary to the players in level 4. Performing a Search 1. Go the the BLAST page again. This time choose the link to the Standard nucleotide-nucleotide BLAST and run a blastn search against the nr database with the following DNA sequence. This time, however, leave the 'Choose filter' box checked so that the sequence will be filtered for low complexity regions. Leave all of the other parameters at default as above. The filter option ensures that no false positive results are obtained due to short sequences that are very common across the spectrum of biological sequences. Be aware, however, that if the sequence is filtered, sometimes regions are X'ed out and an exact match sequence in the database may show only around 95% identity even though it is the same sequence. >unknown DNA
tblastx compares the six-frame translations of a nucleotide query sequence against the six-frame trans-lations of a nucleotide sequence database.


text:
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Hotfrog NewZealand provides information regarding Culturalbased-Art in Auckland. Culturalbased-Art is located at 14 Highbury Street, Auckland Auckland and provides Art Dealers and Galleries services. Contact them on 021 136 4704 or by visiting them on their website http://www.culturalbased-art.com.
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Inform Bold Shadow Cyrillic Fonts
<link href="//db.onlinewebfonts.com/c/f2f2cc01a3cde5451b0ea9aad0b3774c?family=InformShadowC" rel="stylesheet" type="text/css"/>#2 Using @import CSS directive, put the following line in add to your css file.(http | https)
@import url(//db.onlinewebfonts.com/c/f2f2cc01a3cde5451b0ea9aad0b3774c?family=InformShadowC);#3 Use font-face declaration Fonts.(http | https)
@font-face {font-family: "InformShadowC"; src: url("//db.onlinewebfonts.com/t/f2f2cc01a3cde5451b0ea9aad0b3774c.eot"); src: url("//db.onlinewebfonts.com/t/f2f2cc01a3cde5451b0ea9aad0b3774c.eot?#iefix") format("embedded-opentype"), url("//db.onlinewebfonts.com/t/f2f2cc01a3cde5451b0ea9aad0b3774c.woff2") format("woff2"), url("//db.onlinewebfonts.com/t/f2f2cc01a3cde5451b0ea9aad0b3774c.woff") format("woff"), url("//db.onlinewebfonts.com/t/f2f2cc01a3cde5451b0ea9aad0b3774c.ttf") format("truetype"), url("//db.onlinewebfonts.com/t/f2f2cc01a3cde5451b0ea9aad0b3774c.svg#InformShadowC") format("svg"); }
Copyright (c) 1990-1999 ParaType
DK Hasty Tasty
DK Hasty TastyStyle
David KerkhoffAuthor
David KerkhoffTrademark
DK Hasty Tasty is a trademark of David Kerkhoff.Copyright
Copyright (c) 2011 by David Kerkhoff. All rights reserved.Description
Copyright (c) 2011 by David Kerkhoff. All rights reserved.License
DEMO / Donationware
Madurai Slab W01 Cnd Bd
Jeremy DooleyAuthor
Madurai is a trademark of Jeremy Dooley.Copyright
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Copyright (c) 2012 by . All rights reserved.
Free For Personal UseLicense
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Helvetica Neue LT Com 23 Ultra Light Extended
Style : 23 Ultra Light ExtenPackages
Helvetica Neue LT ComStyle
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2.00; 2006Company
Linotype GmbHAuthor
Linotype Design StudioTrademark
Helvetica is a trademark of Heidelberger Druckmaschinen AG, exclusively licensed through Linotype GmbH, and may be registered in certain jurisdictions.Copyright
Part of the digitally encoded machine readable outline data for producing the Typefaces provided is copyrighted 2006 Linotype GmbH, www.linotype.com. All rights reserved. This software is the property of Linotype GmbH, and may not be reproduced, used, displayed, modified, disclosed or transferred without the express written approval of Linotype GmbH. Copyright 1988, 1990, 1993 Adobe Systems Incorporated. All Rights Reserved. Helvetica is a trademark of Heidelberger Druckmaschinen AG, exclusively licensed through Linotype GmbH, and may be registered in certain jurisdictions. This typeface is original artwork of Linotype Design Studio. The design may be protected in certain jurisdictions.Description
Helvetica is one of the most famous and popular typefaces in the world. It lends an air of lucid efficiency to any typographic message with its clean, no-nonsense shapes. The original typeface was called Haas Grotesk, and was designed in 1957 by Max Miedinger for the Haas'sche Schriftgiesserei (Haas Type Foundry) in Switzerland. In 1960 the name was changed to Helvetica (an adaptation of Helvetia, the Latin name for Switzerland). Over the years, the Helvetica family was expanded to include many different weights, but these were not as well coordinated with each other as they might have been. In 1983, D. Stempel AG and Linotype re-designed and digitized Neue Helvetica and updated it into a cohesive font family. Today, the original Helvetica family consists of 34 different font weights, and the Neue Helvetica family consists of 51 font weights. The Helvetica family now forms an integral part of many digital printers and operating systems and has become a stylistic anchor in our visual culture. It is the quintessential sans serif font, timeless and neutral, and can be used for all types of communication. Helvetica World, an update to the classic Helvetica design using the OpenType font format, contains the following Microsoft code pages: 1252 Latin 1, 1250 Latin 2 Eastern, 1251 Cyrillic, 1253 Greek, 1254 Turk, 1255 Hebrew, 1256 Arabic, 1257 Windows Baltic, 1258 Windows Vietnamese, as well as a mixture of box drawing element glyphs and mathematical symbols & operators. In total, each weight of Helvetica World contains more than 1850 different glyph characters!License
NOTIFICATION OF LICENSE AGREEMENTYou have obtained this typeface software either directly from Linotype GmbH or together with software distributed by one of Linotype's licensees.This software is a valuable asset of Linotype GmbH. Unless you have entered into a specific license agreement granting you additional rights, your use of this software is limited to your workstation for your own use. You may not copy or distribute this software. If you have any questions regarding your license terms, please review the license agreement you received with the software.General license terms and usage rights can be viewed at www.linotype.com/license.Generelle Lizenzbedingungen und Nutzungsrechte finden Sie unter www.linotype.com/license.Pour plus d'informacin concernant la contrat d'utilisation du logiciel de polices, veuillez consultez notre site www.linotype.com/license.Linotype GmbH can be contacted at:Tel.: +49(0)6172 484-418
Source Code Pro ExtraLight V1
Source Code Pro ExtraLightStyle
1.010;PS 1.000;hotconv 1.0.70;makeotf.lib2.5.5900Company
Adobe Systems IncorporatedAuthor
Paul D. HuntTrademark
Source is a trademark of Adobe Systems Incorporated in the United States and/or other countries.Copyright
Copyright 2010, 2012 Adobe Systems Incorporated. All Rights Reserved.License
Copyright 2010, 2012 Adobe Systems Incorporated (http://www.adobe.com/), with Reserved Font Name 'Source'. All Rights Reserved. Source is a trademark of Adobe Systems Incorporated in the United States and/or other countries.This Font Software is licensed under the SIL Open Font License, Version 1.1.This license is copied below, and is also available with a FAQ at: http://scripts.sil.org/OFL-----------------------------------------------------------SIL OPEN FONT LICENSE Version 1.1 - 26 February 2007-----------------------------------------------------------PREAMBLEThe goals of the Open Font License (OFL) are to stimulate worldwide development of collaborative font projects, to support the font creation efforts of academic and linguistic communities, and to provide a free and open framework in which fonts may be shared and improved in partnership with others.The OFL allows the licensed fonts to be used, studied, modified and redistributed freely as long as they are not sold by themselves. The fonts, including any derivative works, can be bundled, embedded, redistributed and/or sold with any software provided that any reserved names are not used by derivative works. The fonts and derivatives, however, cannot be released under any other type of license. The requirement for fonts to remain under this license does not apply to any document created using the fonts or their derivatives.DEFINITIONSFont Software refers to the set of files released by the Copyright Holder(s) under this license and clearly marked as such. This may include source files, build scripts and documentation.Reserved Font Name refers to any names specified as such after the copyright statement(s).Original Version refers to the collection of Font Software components as distributed by the Copyright Holder(s).Modified Version refers to any derivative made by adding to, deleting, or substituting -- in part or in whole -- any of the components of the Original Version, by changing formats or by porting the Font Software to a new environment.Author refers to any designer, engineer, programmer, technical writer or other person who contributed to the Font Software.PERMISSION & CONDITIONSPermission is hereby granted, free of charge, to any person obtaining a copy of the Font Software, to use, study, copy, merge, embed, modify, redistribute, and sell modified and unmodified copies of the Font Software, subject to the following conditions:1) Neither the Font Software nor any of its individual components, in Original or Modified Versions, may be sold by itself.2) Original or Modified Versions of the Font Software may be bundled, redistributed and/or sold with any software, provided that each copy contains the above copyright notice and this license. These can be included either as stand-alone text files, human-readable headers or in the appropriate machine-readable metadata fields within text or binary files as long as those fields can be easily viewed by the user.3) No Modified Version of the Font Software may use the Reserved Font Name(s) unless explicit written permission is granted by the corresponding Copyright Holder. This restriction only applies to the primary font name as presented to the users.4) The name(s) of the Copyright Holder(s) or the Author(s) of the Font Software shall not be used to promote, endorse or advertise any Modified Version, except to acknowledge the contribution(s) of the Copyright Holder(s) and the Author(s) or with their explicit written permission.5) The Font Software, modified or unmodified, in part or in whole, must be distributed entirely under this license, and must not be distributed under any other license. The requirement for fonts to remain under this license does not apply to any document created using the Font Software.TERMINATIONThis license becomes null and void if any of the above conditions are not met.DISCLAIMERTHE FONT SOFTWARE IS PROVIDED AS IS, WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT OF COPYRIGHT, PATENT, TRADEMARK, OR OTHER RIGHT. IN NO EVENT SHALL THE COPYRIGHT HOLDER BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER LIABILITY, INCLUDING ANY GENERAL, SPECIAL, INDIRECT, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM, OUT OF THE USE OR INABILITY TO USE THE FONT SOFTWARE OR FROM OTHER DEALINGS IN THE FONT SOFTWARE.
History Lowercase Regular
History LowercaseStyle
Daniel LyonsTrademark
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Copyright Daniel Lyons 2015Description
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FontStruct Non-Commercial License
2008; 1.0, initial releaseCopyright
Copyright (c) bobistheowl for Metaphase Brothel Graphix, 2008. All rights reserved. Freeware forever! Visit the Metaphase Brothel Graphix homepage at http://cg.scs.carleton.ca/~luc/bobistheowl.html, for more great fonts that aren't compatible with Windows Vista.Description
Copyright (c) bobistheowl for Metaphase Brothel Graphix, 2008. All rights reserved. Freeware forever! Visit the Metaphase Brothel Graphix homepage at http://cg.scs.carleton.ca/~luc/bobistheowl.html, for more great fonts that aren't compatible with Windows Vista.
CF Gothika Regular
CF GothikaStyle
1.00 2013Company
Steve CloutierTrademark
CF Gothika is a trademark of CloutierFontes.Copyright
Copyright (c) 2013 by CloutierFontes. All rights reserved.Description
CF Gothika Regular is a font by CloutierFontes, designed by Steve Cloutier in 2013.
Helia Core W01 Bold Italic
Nico InosantoTrademark
Helia Core Bold Italic is a trademark of Nico Inosanto.Copyright
Copyright (c) 2013 by Nico Inosanto. All rights reserved.Description
Copyright (c) 2013 by Nico Inosanto. All rights reserved


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- Books
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Learning Axure RP Interactive PrototypesBy: John Henry Krahenbuhl (author)Paperback
4 - 6 days availability
DescriptionIf you are a user experience professional, designer, information architect, or business analyst who wants to gain interactive prototyping skills with Axure, then this book is ideal for you. Some familiarity with Axure is preferred but not essential.
Create a review
About AuthorJohn Henry Krahenbuhl has over 20 years of experience in architecting practical, cost-effective, and innovative solutions. Being a creative thinker and having an entrepreneurial spirit has enabled him to be the lead or co-inventor on numerous utility patent applications. He is a multifaceted, collaborative management professional who is highly skilled at managing products through the entire life cycle, from design to obsolescence, including specification and use case definitions, schematic and PCB layouts, production software implementation, and hardware implementation. He's a passionate, resourceful leader who demands and delivers excellence in design and user experience.
Product Details
- publication date: 31/01/2015
- Format: Paperback
- Number Of Pages: 362
- weight: 621
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The 1920s, one of the most important periods in Irish history, saw the foundation of the Irish Free State, which lead to the modern Irish Republic. At the end of British rule in Ireland all the old British Post boxes were painted green and the harp of the Irish State replaced royal insignia on official items. Many of these historic mail boxes are still in use in Ireland today.
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"Often letter anthologies are the purview of a subject's near-evangelical followers, but Africa in My Blood is an engrossing primate primer, a treat for old fans, and a fitting tribute to the woman who first made science friendly."Biography Magazine
"An intimate and vivid portrait"Natural History Magazine
"Jane Goodall is more than just a remarkable scientist. She is, as other writers have noted, a real-life Horatio Alger.... this is a valuable book." The San Francisco Chronicle
"No one, perhaps, has done more for great apes than Goodall, whose decades of work with Kenyan chimpanzees showed the rest of the world how chimps livehow they use tools, eat, sleep, have sex, raise their young, fight, make peacedemonstrating that they deserve further study as well as human protection. Here, in a follow up to last year's spiritual autobiography Reason for Hope, are displayed the roots of that work, in a thick, fun, enlightening, somewhat diffuse compilation of letters that Goodall wrote to relatives, friends, and colleagues over the first 32 years of her life, now amplified by Peterson's introduction and annotations. The earliest letters show the preteen Valerie Jane Morris-Goodall at school in England, chattily inviting her best friend to see her collection of "quite a lot of caterpillars." Later batches describe life in "Chimpland," where Goodall and her co-workers have set up their ongoing project. We see a mother chimp and her neighbors react to a baby; we also see Goodall, then-husband Hugo van Lawick and a cast of dozens handle the practical problems of running a jungle encampment, from parasites to postage and publicity. Goodall describes her work with her mentor, paleontologist Louis Leakey; shows her continued affection for her family; keeps up with U.S. and European animal-behavior researchers such as Konrad Lorenz; and narrates "the proudest [day] of my whole life to date": the chimpanzee "David Gyeshe has TAKEN BANANAS FROM MY HAND." This volume covers only the "early years" (1934-1966); readers who care about animal behavioror who enjoy the collected letters of a fascinating, friendly, and dedicated womanwill hope for a sequel."Publishers Weekly, March 6, 2000
Publishers Weekly
"A sumptuous delight! A story of greatness bred from innocence and wonder of one of the most remarkable lives of our time. As Africa grips Jane Goodall, her story grips the reader. AFRICA IN MY BLOOD allow us to witness, in a very intimate way, how the early seeds of understanding and compassion for chimpanzees changed the very understanding of what it means to be human. Jane's personal letters make you feel like you are a member of the family. This absolutely MUST become the first of a trilogy! The "heart" and the "soul" must join the "blood". I can hardly wait- it wasn't fair to leave us in 1966 when we know there is so much more."Roger Fouts (Chimpanzee and Human Communication Institute, Central Washington University)


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Dog health care
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12 Facts About Your Canine's Canines Infographic
Steps to clean your dog's ears during those NYC snow storms! For all your pet needs visit your closest Duane Reade or check out Duanereade.com!
Help exists for those struggling to pay veterinary bills - VIN: Good read about organizations that offer financial assistance for veterinary care - includes a list of such organizations.
Like our own feet, our dogs' paws need caring for too. Try these winter dog paw care tips for a happy pooch! http://www.menards.com/main/c-19276.htm?utm_source=pinterest&utm_medium=social&utm_campaign=petcenter&utm_content=paw-care&cm_mmc=pinterest-_-social-_-petcenter-_-paw-care
The home remedies for dog allergies consist of some natural remedies which reduce the infection and skin inflammation. The steps to use home remedies are very simple and after application your dog will get quick relief from the infection. www.1800remedies.com
Simple Trick To Calm Your Pets During Fireworks
It's important to recognize the signs of stress to give your dog a break and B.A.T. proactive training gives reactive dogs the tools they need to succeed. Learn more: http://thebark.us/227cYJu
Coconut Oil for Pets: Uses, Benefits, and Tips! - Coconut Oil Tips
What Human Food is Good For Your Dog | Infographic


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iPhone apps
The Rating Game: The Foolproof Formula for Finding Your Perfect Soul Mate by Reba Toney
The Rating Game: The Foolproof Formula for Finding Your Perfect Soul MateReba ToneySt. Martin's GriffinJune 9 2009The Theory: if you're always getting dumped it's because you're dating people who are better than you. If you're always dumping….. Read more
What's New in Version 3.0.1
- Improved compatibility with iPad
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text: Seller: antzy (1,894) 100%, Location: Gorham, Maine, Ships to: Worldwide, Item: 322317383965 2 Sets of Vintage Clear Glass Door Knobs with all hardwareOne set has brass hardware the other has chrome hardwareThere is a slight difference in the glass patterns (see pics)Both in Great condition with some paint on hardware (easily removed )Sold as-isShipping USA = $ 11.40 Shipping International = calculated by location & weight Payment: PayPal Only. PayPal accepts most credit cards and e-checks.We do combine shipping costs to lower shipping fees when purchasing Multiple items. Please notify us of your intent to purchase more than one item. visit my listings - http://shop.ebay.com/antzy/m.html?_trksid=p4340.l2562 Color: Clear, Material: Glass


text: Friday, 2 September 2016 Banky W spotted with Zahra Buhari at #GetInvolved Banky W was pictured with president's daughter, Zahra Buhari, during the launch of Future Assured's #GetInvolved initiative today. The singer was pictured also with Information minister Lai Mohammed and others. Banky also met president Buhari's wife Aisha Buhari and actress Joke Silva at the Wednesday 30 August 2016 leg of the same event. Share on Facebook Share on Twitter Share on Google Plus How to stay updated: Install 'Somtoo Okoye blog' app (Direct Download) (Google Play) | Follow on Facebook & Twitter Written by Somtoo Okoye on 7:40 pm, Friday, 2 September 2016 Edit Post


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NBA 2w ago
Ryan Anderson cut his thumb on trash and 8 other super-relatable athlete injuries
We are all Ryan Anderson.
We are all Ryan Anderson.
After a very weird absence from Monday's game, the Knicks tweeted out this photo of guard Derrick Rose attending practice on (…)
Sounds like it was a successful Thanksgiving at the Anthony's.
The best of turkey day 2016.
Injuries have seriously taken its toll on Derrick Rose's career, but the innate talent is still there, and fans still catch flashes of (…)
He says this has nothing to do with politics.
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A large number of connecting rod manufacturers have chosen ARP bolts as standard equipment. They're proud to advertise their products as being equipped with ARP rod bolts. And for good reason. The "weak link†in a connecting rod has always been the bolt, and racers know that nobody builds a better bolt than ARP. However, it is critically important to monitor the stretch of each bolt and replace it when it has permanently elongated by .0005Ë. Below you will find an extensive listing of aftermarket connecting rods and replacement bolt specifications.
In some instances, you may want to go to an ARP rod bolt made from a better grade of material. This will provide you with improved reliability. However, please understand that when you want bolts made from exotic, super high strength materials, the cost will increase significantly. If you're on a budget, it's best to go with the most cost-effective solution. This is typically defined by the loads that are carried by the bolts in terms of piston/rod weight and the rotational speed of the engine. The most cost effective design is the one in which the bolt strength is just great enough to handle its anticipated load – plus a safety margin for the occasional overloads. Using a material which has far more strength than required is not as cost effective – but will definitely give you an extra margin of safety and longer service life.
You should also know that ARP rod bolts are superior to those from other manufacturers. Especially in the area of fatigue strength. Testing has shown ARP rod bolts to have ten times the fatigue strength of other bolts. In the chart below, you'll find a bar chart that graphically shows the difference between ARP Pro Series rod bolts and the fastener made by a leading competitor. It's easy to see why ARP bolts are superior. As such, it makes good sense to rely on ARP for optimum connecting rod service and reliability. Make the most of your racing budget and rely on ARP rod bolts. You'll find the ARP name proudly stamped on each bolt as your assurance of quality.
Forged in-house at ARP using only the finest quality materials
Heat-treated using special vertical racks to assure complete 360° penetration
Threads rolled after heat-treat to provide up to 10-times longer fatigue strength
Precision CNC-machined to exacting specifications
Specially designed for optimum reliability in each application
Wave-Loc Features
Wave-Loc surface contacts the rod and cap for optimum alignment and reduction of fluctuating stress – which strengthens the rod itself!
Provides snug fit for all OEM connecting rods (interference range of .001Ë to .005Ë), despite wide range of factory rod bolt hole tolerances.
Available for most applications.
Superior material grain flow because of patented Wave-Loc surface design as compared to knurled bolts that have sharp edges and "built-in†stress risers.
Galling and scoring of the rod is virtually eliminated because there
is only smooth contact and absolutely no "digging.â€
Materials Used In ARP Connecting Rod Bolts
8740 CHROME MOLY: Until the development of today's modern alloys, chrome moly was popularly considered a high strength material. Now viewed as only moderate strength, 8740 chrome moly is seen as a good tough steel, with adequate fatigue properties for most racing applications, but only if the threads are rolled after heat-treatment, as is the standard ARP production practice. Typically, chrome moly is classified as a quench and temper steel, that can be heat-treated to deliver tensile strengths between 180,000 and 210,000 psi.
AERMET: With a typical tensile strength of 290,000-310,000 psi, Aermet is a new martensitic super-alloy that is stronger and less expensive than the super-alloy austenitic materials that follow. Because it is capable of achieving incredibly high clamping loads, it is ideal for short b
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Grandmother Brown's Hundred Years, 1827-1927.
BROWN, Harriet Connor.
Place Published: Boston
Publisher: Little Brown
Date Published: 1929
Description: Illustrated in black & white. Tall thick 8vo, green cloth and gilt lettering. Boston: Little, Brown, and Co., 1929.Jacket: N
Binding: hardcover
Condition: very good(+)
Language: English
Type: Books
Book ID: 248808
By This Author: BROWN, Harriet Connor.
By This Publisher: Little Brown


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text: What do you think of RE Corps Enterprises based out of Chatham? Specifically is there anything that you think they should stock but currently do not? Do you have any other comments on level of service, ease of purchase or anything else positive or negative? I am not a journo or anything else, rather a serving WO who's been "volunteered" to do some research and I couldn't think of a better place to start than here. Any feedback gratefully received, though if you have any particularly negative comments it may be better to PM me rather than wash the Corps dirty linen in public. I will certainly pass them on. Corps Enterprises is very keen to provide the best service it possibly can. RE Corps Enterprises is a Limited company in its own right which is owned by the Corps of Royal Engineers and run for the benefit of current serving Officers and Soldiers, retired members of the Corps and their families. The Corps shop and mail order centre is located in Brompton Barracks, Chatham, the âhistoricalâ home of the Corps. All profits generated by sales are gift aided to the Royal Engineers Central Charitable Trust at the end of each financial year.


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Dynafit ALPINE THERMO BOTTLE 0,5L
Insulated lightweight skiing bottle, 0,5l.
Insulated lightweight skiing bottle, 0,5l.
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We're raising £200 to The money raised will help the development of sport within Sheffield reach children in need of opportunities to improve there health.
- Time left
- 9 days to go
What is crowdfunding?
Crowdfunding is the new way to raise money for a personal cause on JustGiving.
AG Sports had been created in Sheffield back In July 2016. The main purpose of this non-for profit organisation was to gain a foot hold within an area of the city to ensure that opportunities in sport was given to all children from all aspects of life. The first activity which we are offering to children is football related activities which start at the age of 18 month to 15 years of age.
AG Sports feel that all individuals of a young age should be given an opportunity to learn sport, developing the social skills that they need such as interaction and communication but also have a chance of taking part within Sport with no pressures added to this. Sport is a powerful tool and we are expanding opportunities into other areas of the city to ensure that more opportunities are achieved for participation and coaching aspiration's. Help us by achieving this main aim of providing a long term goal of which is to provide sporting opportunism to young children within Sheffield.
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Shea Butter
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Shea Butter
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Barcelona got crushed because PSG completely eviscerated their midfield
Barcelona walked into the Parc des Princes as heavy favorites to topple Paris Saint-Germain and put one foot into the Champions League quarterfinals. Instead, they left in shambles, having been completely torn apart by PSG, 4-0, and left to wonder what happened to their midfield.For all the talk about Lionel Messi, Luis Suarez and Neymar, Barcelona's feared trio didn't matter so...
Via FOX Sports
10 days ago
Antoine Griezmann drops a big hint that he's not set on Manchester United
Antoine Griezmann's been the subject of rampant transfer speculation for the last year-plus, and Manchester United's interest in the little Atletico Madrid striker has been anything but a secret. Reports of personal terms being agreed, Paul Pogba convincing his countryman United is the place to be, and even his image consultant making googly eyes at United have lead many to believe...
Via FOX Sports
11 days ago
Luis Suarez out of Copa del Rey final after red card suspension upheld
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Via FOX Sports
16 days ago
Neymar's improvement at Barcelona credited to Lionel Messi, but due to Luis Suarez
Neymar came with much fanfare when he joined Barcelona, but ultimately disappointed in his first season at the Camp Nou. It is not to say the Brazilian played poorly, but the boy proclaimed as world football's next big thing managed eight goals and nine assists in 26 appearances in his first season in Catalonia. That is far from the expected production for such a hyped-up player...
Via The Sports Quotient
December 17, 2016 | Discuss
Luis Suarez Throws Sideline Tantrum After Benching In Uruguay's Loss
Uruguay had a rather unceremonious exit from Copa America 2016 on Thursday night, and Luis Suarez did not like how everything went down. La Celeste suffered a shocking 1-0 defeat to Venezuela in group stage play that eliminated them from the tournament. Suarez didn't play a minute in the match, and after Uruguay manager Oscar Tabarez made his final substitution to ensure Suarez...
Luis Suarez throws fit during Venezeula's upset over Uruguay
Well, who could have predicted that? Venezuela, the team which is solidly in last place in CONMEBOL World Cup Qualifying, has two wins in two games and has just upset the 15-time Copa America champs Uruguay, kicking Uruguay into being all but eliminated in the Copa America Centenario. The game started very physically as both teams had players going to ground. It almost rivaled...
Luis Suarez Gloats About FIFA's Demise, As World Cup Bite Ban Finally Ends
Luis Suarez is finally free. That is, free to play international soccer competitively again. Suarez has finished serving the nine-game ban FIFA gave him in 2014 for biting Italy defender Giorgio Chiellini at the last World Cup in Brazil. On Tuesday, the Uruguay striker reflected on his lengthy suspension but also seemed to delight in the hits FIFA has taken in the last year amid...
Barcelona's Luis Suarez Scores Magical Volley In Champions League (Video)
Luis Suarez didn't need to remind Arsenal of his immense talent but he did anyway. Suarez scored a sensational goal Wednesday in FC Barcelona's UEFA Champions League game against Arsenal. The Uruguayan made the score 2-1 in the 65th minute when he volleyed Dani Alves' cross past goalkeeper David Ospina from around 10 yards out. Stop it, Luis Suarez. Just stop it. #UCL ...
Luis Suarez: Liverpool Only English Team I'll Play For; Fans Remain In My Heart
The bond Luis Suarez shares with Liverpool FC and its fans didn't break when he joined Barcelona in July 2014. Suarez revealed to ESPN on Tuesday that he'd only play for Liverpool should he ever return to the Premier League, according to The Press Association. Suarez wasn't hinting a possible return is in the works, but his affection for his former club was evident in his comments...
Barcelona's Luis Suarez suspended two games for scrum
Barcelona striker Luis Suarez was banned two games by Copa del Rey after the referee accused him of provoking Espanyol players. Barcelona came back from behind to win the match 4-1, but it was quite the heated contest. Espanyol had two players sent off. There perhaps should have been a third, as Pau Lopez appeared to stamp on Lionel Messi. Witnesses say Suarez provoked a scuffle...
Via The Comeback
January 08, 2016 | Discuss
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Distribution of patients with subglottic stenosis in our study.
Walner DL, Stern Y, Gerber ME, Rudolph C, Baldwin CY, Cotton RT. Gastroesophageal Reflux in Patients With Subglottic Stenosis. Arch Otolaryngol Head Neck Surg. 1998;124(5):551-555. doi:10.1001/archotol.124.5.551
© 2017
To determine the incidence of gastroesophageal reflux in patients with subglottic stenosis (SGS) and to determine if upper esophageal reflux occurs in addition to lower esophageal reflux in these patients.
Esophageal pH probe studies were reviewed in patients diagnosed as having SGS.
A tertiary care pediatric medical center.
All patients diagnosed as having SGS between January 1990 and July 1996 who had undergone monitoring with an overnight esophageal pH probe. Seventy-four patients qualified for the study. All 74 patients underwent lower probe testing, and 55 of the 74 underwent dual (upper and lower) probe testing.
Main Outcome Measures
The percent of time a pH measurement of less than 4.0 was recorded in the upper and lower esophagus. A lower probe pH measurement of less than 4.0 more than 10% of the study time was considered high risk for developing reflux-associated pathologic symptoms. A lower probe pH measurement of less than 4.0 for 5% to 10% of the study time was considered a marginal risk for developing reflux-associated pathologic symptoms. Upper probe criteria for reflux-associated symptoms have not been established. Therefore, patients were grouped as having a pH of less than 4.0 in the upper esophagus for 0%, 0.1% to 0.9%, 1.0% to 1.9%, 2.0% to 3.0%, or more than 3% of the study time.
Thirty-seven of the 74 patients who underwent lower probe testing had a pH of less than 4.0 more than 5% of the study time, and 24 had a pH of less than 4.0 more than 10% of the study time. Twelve of the 55 patients who underwent upper probe testing had no measurable reflux; 27 of the 55 had a pH of less than 4.0 more than 1% of the study time; 14 had a pH of less than 4.0 more than 2% of the study time, and 11 had a pH of less than 4.0 more than 3% of the study time.
Gastroesophageal reflux is frequently present in patients with SGS. Gastric contents frequently reach the upper and lower esophagus in these patients. In addition, the high incidence of gastroesophageal reflux in these patients suggests that it may play a role in the development of SGS. The possible effect of gastroesophageal reflux on the surgical repair of SGS requires further study.
THE INCIDENCE of subglottic stenosis (SGS) in neonates requiring endotracheal intubation ranges from 1% to 8%.1,2 The cause of acquired SGS is not well understood.3 Several synergistic factors likely play a role in the development of the disorder. These factors include but are not limited to the size of the endotracheal tube, movement of the endotracheal tube, duration of intubation, traumatic intubation, presence of an infection while intubated, and possibly gastroesophageal reflux (GER) with or without intubation.
Gastroesophageal reflux occurs when gastric contents move in a retrograde direction into the esophagus. Brief episodes of GER occur in almost 50% of healthy infants less than 2 months of age.4 By the age of 12 months and thereafter, only 8% of children are thought to have GER.5 In most infants and children, GER has no consequences, but airway symptoms have been shown to be related to GER in some patients. These symptoms include aspiration pneumonia, exacerbation of asthma, apnea, stridor, croup, and laryngitis or hoarseness.6- 8 More specifically, Jindal et al9 suggest that GER may cause certain cases of SGS. Contencin et al6 comment on the close relationship between SGS and GER. This relationship could have implications for both the origin of SGS and its treatment if GER is present. The prevalence of GER in patients with SGS has not been clearly established.
The purpose of our study was to determine the prevalence of GER in pediatric patients with SGS.
A list was reviewed of all patients evaluated for SGS at the Children's Hospital Medical Center in Cincinnati, Ohio, between January 1990 and July 1996. Of the more than 300 patients evaluated, only those who had undergone pH probe testing at our institution were included in the study. Many patients had undergone GER evaluation at other institutions, and as a result, details of their pH studies were unavailable, and they were not included in the study. Seventy-four patients qualified for the study, and a retrospective chart review was performed for each.
The following information was recorded for each patient: sex, age at the time of testing, the presence of a tracheotomy tube at the time of testing, associated medical conditions and birth history, previous reflux surgery, grade of airway stenosis identified on endoscopy, and number of previous airway surgeries. Airway grading was recorded from the endoscopy performed closest to the date of pH probe testing and was based on the Myer/Cotton grading system (Figure 1).10
All dual-probe monitoring was performed with a portable pH measuring unit (model Mk3 dual-channel Digitrapper, Synectics Medical). Single-probe studies were performed with a Mark II single-channel unit (Synectics Medical. Most dual-probe studies were performed in the latter half of the study (1993-1996). All electrodes were calibrated in buffer solutions with a pH of 7.0 and then in solutions with a pH of 1.0. The pH electrodes were inserted through the patient's nose into the esophagus and placed such that the tip of the electrode was 2 to 4 cm above the gastroesophageal junction. When present, the upper probe was positioned within 1 to 2 cm of the upper margin of the esophagus. Ideally, the probe was placed below the upper esophageal sphincter in the esophageal inlet. One of 3 different-sized electrodes was used, depending on the age of the child. For patients from birth to 1 year of age, the proximal sensor of the probe was placed 5 cm above the distal sensor. For patients 1 to 3 years of age, the proximal sensor was placed 10 cm above the distal sensor. For patients 3 years and older, the proximal sensor was placed 15 cm above the distal sensor. All patients underwent fluoroscopy or chest radiography to confirm correct placement of the probe. A reference electrode was placed on the patient's abdomen when required. Recordings were obtained for at least 18 hours.
All patients were instructed to pursue their normal activities. Patients had no meal restrictions, but the beginning and ending of feeding times were recorded. If patients were taking acid-inhibitory or prokinetic medications, those regimens were discontinued at least 24 hours prior to the study (except in one patient who was taking ranitidine hydrochloride [Zantac] during our study because pH probe testing at another institution had indicated severe reflux).
The pH probe results were recorded and distinguished based on upper and lower probe location and the percent of time with a pH measurement less than 4.0. This was calculated by adding the total time within 60 minutes with a pH of less than 4.0 following a meal to the total time for more than 60 minutes with a pH of less then 4.0 following a meal. This sum was then divided by the total time of the study and multiplied by 100 to derive the percent of time with a pH less than 4.0. This calculation was performed separately for upper and lower probe measurements.
Lower pH probe measurements of less than 4.0 were recorded as occurring more than 10% of the study time, 5% to 10% of the study time, or less than 5% of the study time. Upper pH probe results of less than 4.0 were recorded as occurring 0%, 0.1% to 0.9%, 1.0% to 1.9%, 2.0% to 3.0%, or more than 3% of the study time.
Kendall τ rank correlation analysis and nonparametric analysis of variance were performed on all variables mentioned.
Of the 74 patients who qualified for the study, 43 (58%) were male and 31 (42%) were female. The average age of the patients at the time of pH probe testing was 5 years (age range, 0.3-14.3 years). Fifty-five patients (74%) underwent dual (upper and lower) probe testing, and 19 (26%) underwent only lower probe testing.
Sixty (81%) of the 74 patients were dependent on a tracheotomy tube at the time of pH probe evaluation. Of the 44 concomitant medical conditions identified, the most common were prematurity and bronchopulmonary dysplasia:
Eleven patients (14.9%) had undergone Nissen fundoplication prior to our study, and 13 (17.6%) were dependent on a gastrostomy tube. Of the patients who had undergone endoscopy of the airway, 65 (88%) had been diagnosed as having grade II or III stenosis (Figure 1). Twenty-nine (39%) of the 74 patients had undergone previous airway reconstructive surgery, and 6 (21%) of those 29 had undergone previous airway reconstructive surgeries. The high number of previous airway surgeries reflects the referral pattern of our institution.
All 74 patients underwent lower pH probe testing. The results were as follows:
Fifty-five patients underwent dual probe testing and thus had upper probe measurements. The results were as follows:
There was no correlation between grade of airway stenosis and the percent of time with a pH measurement of less than 4.0. A correlation of 0.48 (P<.001) was identified for percent of time with upper and lower pH probe measurements less than 4.0.
Of the 11 patients who required fundoplication prior to our study, 4 now had lower pH probe measurements of less than 4.0 less than 5% of the time, 1 for 5% to 10% of the time, and 6 for more than 10% of the time. The data indicate that 5 of these patients who required fundoplication had significant reflux in the past. However, pH probe testing at our institution indicated no further reflux.
The presence of a tracheotomy tube did not increase the risk of reflux in our study population.
Gastroesophageal reflux is increasingly being recognized as a contributing factor in the pathogenesis of pediatric airway disorders. Such disorders include apparent life-threatening events, recurrent pneumonia, and reactive airway disease.11- 13 The percentage of children with respiratory problems thought to be induced by GER is estimated at 30% in some reports.14
The possibility that GER may cause SGS was first suggested in 1983 by Bain et al,15 who identified GER in 2 adult patients with SGS. This report by Bain et al and one clinical case of their own led Little et al16 to investigate the connection between GER and SGS using a canine model. They applied either water or gastric contents to experimentally induced mucosal lesions or cartilaginous lesions of the trachea. Some animals were treated with histamine2 blockers. The authors concluded that the application of acid to superficial lesions resulted in stenosis and delayed reepithelialization, which did not occur in the superficial lesions to which acid was not applied. Cartilaginous lesions to which acid was applied showed slightly more stenosis than those to which acid was not applied. However, since only 1 animal was in each study group, no significant conclusions could be drawn.
Koufman17 found abnormal lower pH probe results in 23 (72%) of the 32 patients (11 pediatric and 21 adult) he studied with laryngeal and tracheal stenosis. He defined an abnormal lower probe measurement as a pH of less than 4.0 more than 4.39% of the total study time (when the patient was either upright or supine). He found abnormal pharyngeal reflux, defined as any single episode of a pH less than 4.0, in 67% (10/15) of these patients. In another study, Koufman17 induced subglottic mucosal injury in 20 dogs and painted the injured areas with saline solution, acid, or acid with pepsin. Findings included nonhealing and inflammation in the acid with pepsin group.
Based on the aforementioned information, many physicians consider SGS to be a complication of GER.18 With respect to laryngotracheal reconstruction (LTR), Gray et al19 report that patients with uncontrolled GER have a higher rate of failure following surgical reconstruction than those without GER. Based on 20 years of experience, Cotton and O'Connor20 state that a "reflux workup" is now considered essential to the success of LTR. Empirical treatment of GER has been recommended for patients undergoing LTR.21
The importance of GER in LTR has been refuted by Zalzal et al,22 who state that neither the presence of GER nor its treatment are major factors in determining the outcome of LTR. They studied 4 groups of patients who underwent LTR: those who had no preoperative GER evaluation, those whose preoperative GER evaluation findings were normal, those whose preoperative GER evaluation findings were abnormal who failed to receive appropriate treatment, and those whose preoperative GER evaluation findings were abnormal who received appropriate therapy consisting of a prokinetic agent and/or a histamine2 blocker in most cases. Limitations of that study include the fact that it was not double blind, a staging system for airway stenosis was not used, and the sample size of patients with GER was small; as a result, the conclusions of that study are questionable. Although not addressed in that article, 73% of the patients studied had evidence of reflux.
Intraesophageal pH monitoring remains the criterion standard for the diagnosis of GER.6,23,24 Gastroesophageal reflux is best defined by distal esophageal acid exposure, which is identified by a pH of less than 4.0. A confounding factor in the diagnosis of GER is that coughing and wheezing can promote episodes of reflux, such that a child with a tracheotomy tube may have more reflux than a child without a tracheotomy tube. However, these episodes of esophageal acidification are usually brief since acid clears rapidly. A pH of less than 4.0 more than 10% of the time indicates pathologic reflux; a pH of less than 4.0 more than 7% of the study time is associated with an increased risk of esophagitis and airway symptoms related to GER. A pH of less than 4.0 for 5% to 10% of the study time is considered a borderline risk for esophagitis, while GER for less than 5% of the time is considered normal.25
Very few data are available on proximal pH probe results. Ideally, the probe is placed below the upper esophageal sphincter in the esophageal inlet. In a study by Dobhan and Castell,24 minimal acid exposure occurred in the proximal esophagus (<1% of the total time) in patients with normal distal pH probe results. Shaker et al26 evaluated patients with reflux laryngitis using pH monitoring at the distal esophagus, proximal esophagus, and pharynx. Findings included a significantly higher percentage of reflux episodes in the pharynges of patients with laryngitis compared with control patients. The criteria were the number of episodes with pH less than 4.0 in the specified anatomical location. Contencin and Narcy27 monitored pharyngeal pH in infants and children with and without laryngotracheitis. For the pharyngeal channel, acid reflux was defined as a decrease in pH below 6.0. A pathologic condition was diagnosed if a pH of lower than 6.0 was recorded more than 1% of the total time. Another study28 found that patients without distal GER had a proximal esophageal pH of less than 4.0 for 0.76% of the time, while patients with distal GER had a proximal esophageal pH of less than 4.0 for 6.5% of the time. It is currently unclear what pH value should be used as a cutoff to identify pathologic pharyngeal or upper esophageal reflux.
Our lower pH probe data found that more than 30% of the patients with SGS were considered to be at high risk for GER, and that more than 50% were at marginal or high risk for GER. When we included the patients who had previously undergone fundoplication (4 patients) or had severe reflux that had been treated medically (1 patient), the percentage of patients in our study who were at marginal or high risk for GER was 57%. This high incidence of GER in patients with SGS does not provide evidence that GER contributes to SGS; rather, further investigation is needed to determine its significance.
Our study found that 48% of the patients who underwent upper pH probe testing had a pH of less than 4.0 more than 1% of the time. The significance of this value is unclear because upper probe reference data are not available. Our analysis did reveal that most patients with upper reflux more than 1% of the time had lower probe measurements that indicated they were at marginal or high risk for GER. Furthermore, of the 16 patients who underwent dual-probe testing and were considered at high risk for GER based on lower probe testing, 13 had upper reflux more than 1% of the time. This suggests that lower probe data are somewhat predictive of upper probe data.
Although pH probe monitoring is the test used most frequently to determine if GER is present, it must be remembered that pH probe results do not identify basic and neutral GER. If basic or neutral GER is suspected, a gastric-emptying scan should be performed. It is generally accepted that pH probe monitoring is more sensitive and specific in diagnosing GER than a gastric-emptying scan.29 It remains to be seen if laryngeal disorders or biopsy, which theoretically would indicate conclusively whether inflammatory changes are present, will play a role in diagnosing GER in the future. We are currently investigating this question.
A large number of patients in our study were born prematurely and many had other notable associated medical conditions. It is impossible to draw conclusions about the relationship between GER and SGS from this type of retrospective review. In addition, this study does not examine what effect the presence of GER had on these patients after airway reconstruction. What can be learned from these data is that the incidence of GER in patients with SGS seen at our institution was at least 3 times greater than the incidence of GER reported in the general pediatric population. Well-controlled studies are necessary to further our understanding of the role of GER in the pathogenesis of SGS and to determine its impact on the success of reconstructive surgery.
Accepted for publication February 4, 1998.
Presented at the 12th Annual Meeting of the American Society of Pediatric Otolaryngology, Scottsdale, Ariz, May 16, 1997.
Corresponding author: David L. Walner, MD, Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian-St Luke's Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612.