Publications by authors named "Jukka Sipilä"

15 Publications

  • Page 1 of 1

Exercise simultaneously increases nasal patency and bronchial obstruction in asthmatic children.

Respirology 2016 11 6;21(8):1493-1495. Epub 2016 Jul 6.

Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland.

We found that simultaneous post-exercise increase in nasal patency and bronchial obstruction occurs only in children with atopic asthma, but not in sensitized children without asthma. In healthy children, the increase in nasal patency is accompanied by bronchial dilatation.
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http://dx.doi.org/10.1111/resp.12849DOI Listing
November 2016

Nasal nitric oxide is dependent on sinus obstruction in allergic rhinitis.

Laryngoscope 2014 Jun 10;124(6):E213-8. Epub 2014 Feb 10.

Control of Hypersensitivity Diseases Team, Finnish Institute of Occupational Health, Helsinki, Finland.

Objectives/hypothesis: The aim of this study was to evaluate the associations between nasal nitric oxide and nasal symptoms, sinus opacification, and markers of allergic inflammation in allergic and in nonallergic rhinitis while taking into account the effect of sinus obstruction.

Study Design: We studied 175 young adult subjects divided into three groups: 1) allergic rhinitis, 2) nonallergic rhinitis, and 3) controls.

Methods: We measured nasal nitric oxide using the breath-holding method and exhaled nitric oxide and scored semiquantitatively nasal computed tomography scans for opacification and obstruction. We also assessed the visual analogue scores of nasal symptoms, eosinophil count, and interleukin-13 mRNA levels in nasal biopsies.

Results: The level of nasal nitric oxide correlated with exhaled nitric oxide (r = 0.377, P < .001). In allergic rhinitis, nasal nitric oxide was elevated when compared to the controls, and an inverse correlation existed between the nasal nitric oxide level and sinus ostial obstruction (r = -0.272, P = .013). In nonallergic rhinitis, the level of nasal nitric oxide was similar to that of the controls. In allergic rhinitis, nasal nitric oxide correlated positively with the opacification score (r = 0.250, P = .033) and the nasal eosinophil count (r = 0.293, P = .030) of patients without a marked sinus ostial obstruction.

Conclusions: Sinus ostial obstruction lowers the level of nasal nitric oxide and reduces its value as an indicator of allergic mucosal inflammation. A high nasal nitric oxide level may be a useful marker of eosinophilic inflammation in the nasal cavity and indicate the absence of marked sinus ostial obstruction.

Level Of Evidence: 3b.
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http://dx.doi.org/10.1002/lary.24590DOI Listing
June 2014

Physical exercise increases nasal patency in asthmatic and atopic preschool children.

Am J Rhinol Allergy 2013 Nov-Dec;27(6):451-6

Department of Otorhinolaryngology, Turku University Hospital, Turku, Finland.

Background: Physical exercise causes a decrease in nasal mucosal congestion and hence an increase in nasal patency. This nasal response has been studied only in adults. A correlation between nasal obstruction and asthma or allergic rhinitis has been previously found. This study evaluates the influences of atopy and asthma on nasal patency and the changes in nasal patency induced by physical exercise in preschool children.

Methods: An 8-minute exercise challenge test was conducted in 31 children aged between 4.1 and 6.4 years: 13 children had asthma, 17 were atopic, and 13 had neither asthma nor atopy. Nasal patency was measured with acoustic rhinometry at baseline and 10 minutes after the exercise.

Results: At baseline, the total acoustic values were 17-25% larger in nonasthmatic children than in asthmatic children. Accordingly, the acoustic values in nonatopic children were 16-35% larger than in atopic children. After physical exercise, there was an overall increase in mean total nasal volume from 2.973 (SD = 0.647) to 3.405 cm(3) (SD = 0.705), indicating an improvement of 15% in nasal volume (p = 0.025). The increase in nasal patency was similar in asthmatic and nonasthmatic children, as well as in atopic and nonatopic children.

Conclusion: A significant increase in total nasal volume after physical exercise was found in all preschool children. The minimal cross-sectional areas remained smaller in asthmatic and atopic children after exercise, indicating partly irreversible nasal mucosal congestion in these children.
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http://dx.doi.org/10.2500/ajra.2013.27.3956DOI Listing
September 2014

MicroRNA profiles in nasal mucosa of patients with allergic and nonallergic rhinitis and asthma.

Int Forum Allergy Rhinol 2013 Aug 23;3(8):612-20. Epub 2013 May 23.

Control of Hypersensitivity Diseases Team, Finnish Institute of Occupational Health, Helsinki, Finland.

Background: Rhinitis and asthma commonly coexist and are often regarded as "unified airways disease." Evidence exists that microRNAs are important in controlling inflammatory processes, but little is known about their role in airway inflammation. The present study evaluated the inflammatory profiles of patients with allergic rhinitis (AR), with and without concomitant asthma, and of patients with nonallergic rhinitis (NAR).

Methods: We analyzed inflammatory cells, cytokines, and microRNAs from nasal biopsies and measured nasal nitric oxide (nNO) levels in 159 young adult subjects subdivided into 4 groups: (1) AR; (2) AR+asthma; (3) NAR; and (4) controls.

Results: We observed the upregulation of T-helper 2 (Th2) cytokines and the trend of elevation of nNO levels in AR patients compared to controls. Subjects with current AR symptoms had increased levels of miR-155, miR-205, and miR-498, but reduced levels of let-7e. In addition, patients with positive skin prick test (SPT) reactions exhibited increased miR-155 and miR-205 expression and a decreased level of let-7e, compared to subjects with negative SPT findings. Concomitant asthma had little effect on the inflammatory profile of AR. No significant changes in inflammatory markers were found in NAR patients compared to healthy controls.

Conclusion: Our results suggest that microRNAs miR-155, miR-205, miR-498, and let-7e may be important in the allergic inflammation present in nasal mucosa. Regarding NAR, our findings support the view that mechanisms other than inflammation are pivotal.
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http://dx.doi.org/10.1002/alr.21179DOI Listing
August 2013

A follow-up study with acoustic rhinometry in children using nasal insulin.

Rhinology 2010 Mar;48(1):95-9

Department of Otorhinolaryngology, Turku University Hospital, and Department of Biostatistics, University of Turku, Turku, Finland.

Acoustic rhinometry is a widely used method especially suitable with children, since it has no side-effects and is easy to perform. The role of normal development of height or body surface area, and their effect on acoustic rhinometric results, is still a matter of debate. The purpose of this study was to determine the presence of any differences in rhinometric findings or nasal symptoms between children receiving daily administered nasal insulin or placebo. The usefulness of acoustic rhinometry for follow-up in children was also considered. A subcohort of 77 children taking part in the Type I Diabetes Prediction and Prevention Study was invited for a follow-up study with acoustic rhinometry. Children aged 1-12 years received daily either nasal insulin or a placebo. There was no difference between the two groups in nasal symptoms, minimal cross-sectional area or nasal volume measured with acoustic rhinometry. There was likewise no significant increase in rhinometric values during the two years of the follow-up. We conclude that acoustic rhinometry is a suitable method for objective follow-up in children. In a long-term follow-up the normal growth of the child should be taken into account.
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http://dx.doi.org/10.4193/Rhin09.080DOI Listing
March 2010

Nasal insulin to prevent type 1 diabetes in children with HLA genotypes and autoantibodies conferring increased risk of disease: a double-blind, randomised controlled trial.

Lancet 2008 Nov 22;372(9651):1746-55. Epub 2008 Sep 22.

Department of Paediatrics, University of Turku, Turku, Finland.

Background: In mouse models of diabetes, prophylactic administration of insulin reduced incidence of the disease. We investigated whether administration of nasal insulin decreased the incidence of type 1 diabetes, in children with HLA genotypes and autoantibodies increasing the risk of the disease.

Methods: At three university hospitals in Turku, Oulu, and Tampere (Finland), we analysed cord blood samples of 116 720 consecutively born infants, and 3430 of their siblings, for the HLA-DQB1 susceptibility alleles for type 1 diabetes. 17 397 infants and 1613 siblings had increased genetic risk, of whom 11 225 and 1574, respectively, consented to screening of diabetes-associated autoantibodies at every 3-12 months. In a double-blind trial, we randomly assigned 224 infants and 40 siblings positive for two or more autoantibodies, in consecutive samples, to receive short-acting human insulin (1 unit/kg; n=115 and n=22) or placebo (n=109 and n=18) once a day intranasally. We used a restricted randomisation, stratified by site, with permuted blocks of size two. Primary endpoint was diagnosis of diabetes. Analysis was by intention to treat. The study was terminated early because insulin had no beneficial effect. This study is registered with ClinicalTrials.gov, number NCT00223613.

Findings: Median duration of the intervention was 1.8 years (range 0-9.7). Diabetes was diagnosed in 49 index children randomised to receive insulin, and in 47 randomised to placebo (hazard ratio [HR] 1.14; 95% CI 0.73-1.77). 42 and 38 of these children, respectively, continued treatment until diagnosis, with yearly rates of diabetes onset of 16.8% (95% CI 11.7-21.9) and 15.3% (10.5-20.2). Seven siblings were diagnosed with diabetes in the insulin group, versus six in the placebo group (HR 1.93; 0.56-6.77). In all randomised children, diabetes was diagnosed in 56 in the insulin group, and 53 in the placebo group (HR 0.98; 0.67-1.43, p=0.91).

Interpretation: In children with HLA-conferred susceptibility to diabetes, administration of nasal insulin, started soon after detection of autoantibodies, could not be shown to prevent or delay type 1 diabetes.
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http://dx.doi.org/10.1016/S0140-6736(08)61309-4DOI Listing
November 2008

Acoustic rhinometry in children: some practical aspects and influence of age and body surface area on results.

Am J Rhinol 2008 Jul-Aug;22(4):416-9

Department of Otorhinolaryngology, Turku University Central Hospital, Turku, Finland.

Background: Since acoustic rhinometry was described there has been a lack of normal values for minimal cross-sectional area (MCA), especially for children. There has also been debate about factors influencing normal values. The purpose of this study was to find the normal values for children in a Finnish population and whether there is any correlation between age or body surface area (BSA) and MCA.

Methods: We measured 74 children (age, 1-12 years) with an acoustic rhinometer. The values of MCA were compared with age and BSA determined from height and weight.

Results: The mean of unilateral MCA was 0.225 cm2 (SD, 0.041). We found positive correlation between unilateral volume on the left side and age and between MCA from the right side and age or BSA as a constant predictor. As much as 28.4% of the measurements had to be rejected because of acoustic leakage between nostril and nosepiece. Only 6.8% had to be rejected because of a lack of cooperation.

Conclusion: It is possible to find normal values for children. Acoustic rhinometry is well tolerated among children. The method is rapid, reliable and noninvasive, and minimal cooperation is required. The measurements must be performed in a standard way, and some important causes of errors must be kept in mind.
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http://dx.doi.org/10.2500/ajr.2008.22.3197DOI Listing
October 2008

Early percutaneous endoscopic gastrostomy nutrition in head and neck cancer patients.

Acta Otolaryngol 2004 Sep;124(7):847-50

Department of Otorhinolaryngology, North Karelia Central Hospital, Joenuu, Finland.

Objective: Many head and neck cancer patients suffer from poor nutrition. Nutrition is a problem during and after therapy, especially when it consists of extensive surgery, intensive (chemo)radiotherapy or their combination. Additional enteral nutrition has been provided by means of either nasogastric tube feeding, surgical gastrostomy, radiologic percutaneous gastrostomy or percutaneous endoscopic gastrostomy (PEG). Because of the straightforward, easy technique involved and its low complication rate, PEG has become established as the primary route of nutrition in these patients. Previously, the aim of assisted enteral nutrition was to compensate for already existing malnutrition; nowadays, an additional purpose is to diminish or prevent the development of malnutrition. The main objective of this study was to evaluate the safety of pre-treatment PEG in a sample of patients with an upper aerodigestive tract area malignancy treated in a tertiary referral centre.

Material And Methods: A total of 79 patients with an upper aerodigestive tract area malignancy were treated with a total of 80 PEGs during the period 1997-2001.

Results: Most of the PEGs (62/80; 77.5%) were performed by an otolaryngologist. An open gastrostomy was needed in five cases because of unsuccessful gastroscopy due to oesophageal stricture (n=4) or severe trismus (n=1). Both acute and late complications were minor and the respective complication rates (1/80; 1.3% and 12/80; 15%) were low. In addition, all complications were easily managed and did not seriously affect the actual treatment.

Conclusions: A major advantage of having the PEG performed by the otorhinolaryngologist was the possibility to combine it easily with other necessary procedures, such as panendoscopy, tracheostomy and additional biopsy. In addition, the timing of the procedure was easy to schedule.
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http://dx.doi.org/10.1080/00016480410017440DOI Listing
September 2004

Diagnostic value of bronchoalveolar lavage in community-acquired pneumonia in a routine setting: a study on patients treated in a Finnish university hospital.

Scand J Infect Dis 2004 ;36(3):198-203

Department of Medicine, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland.

Only a few previous studies have focused on the use or bronchoalveolar lavage (BAL) in patients with community-acquired pneumonia (CAP). Our aim was to evaluate the diagnostic value of BAL in CAP in a routine clinical setting. 71 disease episodes were retrospectively analysed. The patients had undergone BAL for serious or slowly responding pneumonia. All procedures were performed during antimicrobial treatment of the patient. BAL fluid was cultivated for bacteria, fungi, and viruses. In 68 episodes, 1 or several specific polymerase chain reaction tests were performed. Only 1 (1.3%) quantitative bacterial culture was considered diagnostic for CAP, and indicated a change of antimicrobial treatment. The diagnostic yield increased to 9.8% when other methods were used. A respiratory virus was the only aetiology in 3 (6.0%) patients. In slowly responding pneumonia, also hospital-acquired pathogens and malignancies were identified, resulting in a total diagnostic yield of 20.0%. Thus, even when a large array of diagnostic assays was applied, the value of BAL in pretreated patients with CAP was very small, and its therapeutic implications minimal. In a subgroup of slowly responding pneumonia, the procedure was of some usefulness even after commencement of antimicrobial treatment.
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http://dx.doi.org/10.1080/00365540410019183DOI Listing
June 2004

Intraluminal radiotherapy in esophageal cancer. An update.

Otolaryngol Pol 2004 ;58(1):191-5

Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Central Hospital, Turku, Finland.

Oesophageal cancer is severe illness leading usually to death. Radical surgery is the most successful treatment but most patients are not operable at the time of diagnosis. For these patients external beam radiotherapy with or without concurrent chemotherapy offers the best choice for cure or palliation. In patients with advanced oesophageal cancer, intraluminal brachytherapy has been proposed as an additional method to increase local control. Between 1989-2002, 49 patients with inoperable oesophageal cancer were treated with combined external and intraluminal radiation therapy in Turku University Central Hospital. The external radiation was performed with a median total dose of 40 Gy given in 20 fractions. On the average a week after the external radiation a median total dose of 10 Gy intraluminal radiation therapy was given in 4 fractions. The intraluminal brachytherapy could be performed without technical difficulties and no major complications were seen. In many cases (twenty out of 49 patients, 41%), the symptoms could be relieved immediately and in most cases the progression of the disease could be delayed. The one and two year survival rates were 30% and 18%, respectively. All patients alive at two years can be considered as long-time survivors. Median follow-up was 86 months. Intraluminal brachytherapy is a safe and efficient treatment modality which offers a potential means of cure for selected patients with oesophageal cancer.
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July 2004

Endoscopic lasersurgery in obstructive tracheal and bronchial tumors. An update.

Otolaryngol Pol 2004 ;58(1):187-90

Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Central Hospital, Finland.

Endobronchial tracheal and bronchial obstructive tumors cause severe breathing impairment and may lead to death if the airway can not be maintained. Endoscopic laser surgery is one method to treat these patients. In this study the results of one tertiary care university hospital are analyzed. In the years 1987-1999, in Turku University Hospital, 102 patients were treated with 270 laser treatment sessions, 89 of them for a malignant and 13 for a benign disease. In the years 2000-2002 34 patients were treated in 65 laser treatment session, 21 for a malignant and 13 for a benign disease (Group B). Treatment was performed mostly with a combo CO2-Nd:YAG laser via a rigid bronchoscope, but also a CO2 laser and a fiberoptic Nd:YAG laser were used. The treatment was considered successful in 208 cases of 270 treatment sessions (77%). The most important single factor affecting the success of the therapy was the unfavourable location of the tumor (40 cases). In these cases the tumor was either located too distally in the bronchial tree, or the airway obstruction was found to be caused by extraluminal compression. There were two fatal complications (0.7%). Minor intraoperative bleeding occurred in 7.4% (20/270,) and intraoperative ventilation problems in 7.0% (19/270). In Group B there were one fatal complication (1.5%). Minor intraoperative bleeding occurred in 5 treatment session (7.7%). There were no complications when treating for benign disease. The one-year survival of the patients with malignant disease was 37.1% (33/89), the two-year survival 20.2% (18/89) and the five-year survival 9.0% (8/89). Laser treatment is an effective method in maintaining tracheobronchial ventilation as a palliative treatment modality. Serious complications are possible, but considering the fatal nature of the disease, they must be accepted. In cases of benign diseases, endobronchial laser treatment was very successful.
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July 2004

Panendoscopy and synchronous second primary tumors in head and neck cancer patients.

Eur Arch Otorhinolaryngol 2005 Jan 5;262(1):17-20. Epub 2004 Mar 5.

Department of Otorhinolaryngology, North Karelia Central Hospital, Joensuu, Finland.

Endoscopy techniques are used to diagnose and to determine the extent and exact location of malignancies in the head and neck region, bronchial tree and esophagus. Panendoscopy is used to find the primary tumor in the case of metastatic disease from unknown primaries or to detect a simultaneous second primary tumor at the time of diagnosis of a malignancy in the upper aerodigestive tract (UADT). The value of panendoscopy has been debated lately because of the relatively small proportion of malignant findings and because of the lack of convincing data concerning its effect on survival rates. However, despite the relatively low proportion of positive findings, their significance is often crucial for the individual patient. The significant number of late metachronous, second primaries, especially in the lungs, also emphasizes the importance of follow-up endoscopies. This study consists of 203 consecutive patients with squamous cell cancer (SCC) of the upper aerodigestive tract who underwent panendoscopy in Turku University Central Hospital as part of the initial diagnostic workup from 1992-1999. Eight patients with synchronous second primaries were found to represent a prevalence of 3.9%, and in addition, 19 patients with metachronous tumors were diagnosed. In the case reports we illustrate the importance of some of these findings.
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http://dx.doi.org/10.1007/s00405-004-0743-yDOI Listing
January 2005

Endotracheal and bronchial laser surgery in the treatment of malign and benign lower airway obstructions.

Eur Arch Otorhinolaryngol 2003 Apr 18;260(4):219-22. Epub 2002 Oct 18.

Department of Otorhinolaryngology, North Karelia Central Hospital, Joensuu, Finland.

Lower airway obstruction usually causes a remarkable reduction in the quality of life in cases of both benign and malignant tracheobronchial intraluminal tumor growth. Often this growth can also lead to premature death because of ventilation failure or, indirectly, because of fatal infections. In combination with external radiation therapy, laser surgery has become a standard means of treatment for these patients. From 1987-1999, 102 patients were treated with 270 laser treatment sessions (89 for malignant and 13 for benign diseases) at Turku University Hospital. Treatment was performed mostly with a combination of CO(2)-Nd:YAG laser via a rigid bronchoscope but also with a CO(2) laser and fiberoptic Nd:YAG laser. The treatment was considered successful in 208 cases of 270 treatment sessions (77%). The most important single factor affecting the success of the therapy was the unfavorable location of the tumor (40 cases). In these cases, the tumor was either located too distally in the bronchial tree, or the airway obstruction was found to be caused by extraluminal compression. There were two fatal complications (0.8%). Other complications affecting the quality of the procedure were minor intraoperative bleeding in 7.4% (20/270) and intraoperative ventilation problems in 7.0% (19/270). The 1-year survival of the patients with malignant disease was 37.1% (33/89), the 2-year survival 20.2% (18/89) and the 5-year survival 9.0% (8/89). Laser treatment is an effective method in maintaining tracheobronchial ventilation as a palliative treatment modality. Serious complications are possible, but considering the fatal nature of the disease, laser treatment can be recommended. In cases of benign diseases, endobronchial laser treatment was also very successful.
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http://dx.doi.org/10.1007/s00405-002-0541-3DOI Listing
April 2003

Healing results of prolonged acute frontal sinusitis treated with endoscopic sinus surgery.

Rhinology 2002 Dec;40(4):189-94

Department of Otorhinolaryngology, Turku University Central Hospital, Turku, Finland.

In a marked part of patients suffering from acute frontal sinusitis, the symptoms do not resolve after initial therapy (antibiotics and/or trephination). The prolongation of the healing or recurrences may be caused by persistent inflammation or by structural abnormalities at the nasofrontal connection. During the last decade endoscopic surgery (FES) has become a very useful method to restore the frontonasal drainage although long term results of this kind of population are rare. We evaluated the results of endoscopic surgery in two patient groups (total number of 50) both operated after prolongation (persistent symptoms after 4 weeks) of the initial acute phase of the frontal sinusitis. The first group (A, 15 patients, first trephined) was followed-up 4 years, the number of recurrences after the first FES was 60% and in the other group (B, no initial trephination) with over 6 months follow-up, 91% of patients had recurrences. In group A pre- and postoperative CT-scanning was used to determine the possible anatomical variations that could be causing the failures. All but 3 patients showed some kind of abnormal anatomical variation. In group B only preoperative CT was done. In most cases the reasons for recurrences of frontal sinusitis were polyps and/or chronic inflammation at the ethmoidal region.
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December 2002

Combined external and intraluminal radiotherapy in the treatment of advanced oesophageal cancer.

Radiother Oncol 2002 Jul;64(1):41-5

Department of Otorhinolaryngology, North Karelia Central Hospital, Joensuu, Finland.

Background And Purpose: Oesophageal cancer still has a dismal prognosis. Radical surgery is by far the most successful treatment but most patients are not operable at the time of diagnosis and for these patients external beam radiotherapy with or without concurrent chemotherapy offers the best choice for cure or palliation. In patients with advanced oesophageal cancer, intraluminal brachytherapy has been proposed as a complementary method to increase local control.

Patients And Methods: Between 1989 and 1999, 40 patients with inoperable oesophageal cancer were treated with combined external and intraluminal radiation therapy in Turku University Central Hospital. The external radiation was performed with a median total dose of 40 Gy given in 20 fractions. On the average a week after the external radiation a median total dose of 10 Gy intraluminal radiation therapy was given in 4 fractions.

Results: The intraluminal brachytherapy could be performed without technical difficulties and no major complications were seen. In many cases (16 out of 40 patients, 40%), the symptoms could be relieved immediately and in most cases the progression of the disease could be delayed as evidenced by post-treatment serial endoscopy. No major complications were encountered. The 1- and 2-year survival rates were 30 and 17.5%, respectively. All patients alive at 2 years can be considered as long-term survivors. Median follow-up was 86 months.

Conclusions: Intraluminal brachytherapy is a safe and efficient treatment modality which offers a potential means of cure for selected patients with oesophageal cancer.
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http://dx.doi.org/10.1016/s0167-8140(02)00149-4DOI Listing
July 2002