State of the Arctic October 2006

This State of the Arctic Report presents a review of recent data by an international group of scientists who developed a consensus on the information content and reliability. The report highlights data primarily from 2000 to 2005 with a first look at winter 2006, providing an update to some of the records of physical processes discussed in the Arctic Climate Impact Assessment (ACIA, 2004, 2005). Of particular note: • Atmospheric climate patterns are shifting (Fig. 1). The late winter/spring pattern for 2000–2005 had new hot spots in northeast Canada and the East Siberian Sea relative to 1980–1999. Late winter 2006, however, shows a return to earlier climate patterns, with warm temperatures in the extended region near Svalbard. • Ocean salinity and temperature profiles at the North Pole and in the Beaufort Sea, which changed abruptly in the 1990s, show that conditions since 2000 have relaxed toward the pre-1990 climatology, although 2001–2004 has seen an increase in northward ocean heat transport through Bering Strait (Fig. 2), which is thought to impact sea ice loss. • Sea ice extent continues to decrease. The sea ice extent in September 2005 was the minimum observed in summer during the satellite era (beginning in 1979), marking an unprecedented series of extreme ice extent minima beginning in 2002 (Fig. 3). The sea ice extent in March 2006 was also the minimum observed in winter during the satellite era. • Tundra vegetation greenness increased, primarily due to an increase in the abundance of shrubs. Boreal forest vegetation greenness decreased, possibly due to drought conditions (Fig. 4). • There is increasing interest in the stability of the Greenland ice sheet. The velocity of outlet glaciers increased in 2005 relative to 2000 and 1995, but uncertainty remains with regard to the total mass balance. • Permafrost temperatures continue to increase. However, data on changes in the active layer thickness (the relatively thin layer of ground between the surface and permafrost that undergoes seasonal freezing and thawing) are less conclusive. While some of the sites show a barely noticeable increasing trend in the thickness of the active layer, most of them do not. • Globally, 2005 was the warmest year in the instrumental record (beginning in 1880), with the Arctic providing a large contribution toward this increase. Many of the trends documented in the ACIA are continuing, but some are not. Taken collectively, the observations presented in this report indicate that during 2000–2005 the Arctic system showed signs of continued warming. However, there are a few indications that certain elements may be recovering and returning to recent climatological norms (for example, the central Arctic Ocean and some wind patterns). These mixed tendencies further illustrate the sensitivity and complexity of the Arctic physical system. They underline the importance of maintaining and expanding efforts to observe and better understand this important component of the climate system to provide accurate predictions of its future state.

Histomorphometric analysis of the effects of creatine on rat myometrium

Objective: To analyze the myometrial thickness of rats subjected to creatine (Cr) ingestion. Study design: A total of 14 rats was equally divided into the control group (ConGr) receiving 1 ml potable water and the creatine group (CrGr) subjected to the ingestion of 1.6 g/kg Cr diluted in 1 ml potable water. At the end of 8 weeks, the animals were anesthetized (xylazine and ketamine) and sacrificed, the uteri and ovaries stained with hematoxylin and eosin, the thickness of both the myometrium and the epithelium measured and the follicles counted. Results: Analysis revealed a significant increase in thickness of the myometrium in the CrGr (272.26 +/- 66.71 mu m) contrasted with that from the ConGr (160.76 +/- 35.65 mu m), CrGr > ConGr (p < 0001). Conclusion: Our data suggest that Cr changed myometrial morphology in rats by enhancing myometrial thickness, but its action mechanism in the smooth muscle is still unclear.

Macroscopic and microscopic analysis of the tongue of the common opossum (Didelphis marsupialis)

We performed a macroscopic and microscopic study of the tongues of common opossums, Didelphis marsupialis, from South America. We studied two males and two females. We collected morphometric data on the tongue with precision calipers. For the light microscopy and scanning electron microscopy analyses, we fixed tissue fragments in 10% formaldehyde and 2.5% glutaraldehyde, respectively. The opossum tongues averaged 5.87 +/- 0.20 cm in length, 3.27 +/- 0.15 cm in width at the lingual body, and 3.82 +/- 0.15 cm in width at the root. The mean thickness of the lingual body was 1.8 +/- 0.1 cm, and the thickness of the root was 3.82 +/- 0.15 cm. Sharp filiform papillae were scattered across the entire tongue; conical filiform papillae occurred on the lingual body and tongue tip; fungiform papillae were scattered among the filiform papillae on the lingual body and tongue tip; and there were three vallate papillae at the root of the tongue. We found two strands of papillary projections in the tongue root. Despite the low variability observed in the lingual papillae, the morphological data obtained in this study may be related to the opossum's diverse food habits and the extensive geographic distribution of the species throughout America. Microsc. Res. Tech. 2012. (c) 2012 Wiley Periodicals, Inc.

Jaw mechanics of the pterosaur skull construction and the evolution of toothlessness

In the present study, pterosaur skull constructions were analysed using a combined approach of finite element analysis (FEA), static investigations as well as applying classical beam theory and lever mechanics. The study concentrates on the operating regime „bite“, where loads are distributed via the dentition or a keratinous rhamphotheca into the skull during jaw occlusion. As a first step, pterosaur tooth constructions were analysed. The different morphologies of the tooth construction determine specific operational ranges, in which the teeth perform best (= greatest resistance against failure). The incomplete enamel-covering of the pterosaur tooth constructions thereby leads to a reduction of strain and stress and to a greater lateral elasticity than for a complete enamel cover. This permits the development of high and lateral compressed tooth constructions. Further stress-absorption occurs in the periodontal membrane, although its mechanical properties can not be clarified unambiguously. A three-dimensionally preserved skull of Anhanguera was chosen as a case-study for the investigation of the skull constructions. CT-scans were made to get information about the internal architecture, supplemented by thin-sections of a rostrum of a second Anhanguera specimen. These showed that the rostrum can be approximated as a double-walled triangular tube with a large central vacuity and an average wall-thickness of the bony layers of about 1 mm. On base of the CT-scans, a stereolithography of the skull of Anhanguera was made on which the jaw adductor and abductor muscles were modelled, permitting to determine muscular forces. The values were used for the lever mechanics, cantilever and space frame analysis. These studies and the FEA show, that the jaw reaction forces are critical for the stability of the skull construction. The large jugal area ventral to the orbita and the inclined occipital region act as buttresses against these loads. In contrast to the orbitotemporal region which is subject to varying loading conditions, the pattern in the rostrum is less complex. Here, mainly bending in dorsal direction and torsion occur. The hollow rostrum leads to a reduction of weight of the skull and to a high bending and torsional resistance. Similar to the Anhanguera skull construction, the skulls of those pterosaur taxa were analysed, from which enough skull material is know to permit a reliable reconstruction. Furthermore, FEA were made from five selected taxa. The comparison of the biomechanical behaviour of the different skull constructions results in major transformational processes: elongation of rostra, inclination of the occipital region, variation of tooth morphology, reduction of the dentition and replacement of teeth by a keratinous hook or rhamphotheca, fusion of naris and antorbital fenestra, and the development of bony and soft-tissue crests. These processes are discussed for their biomechanical effects during bite. Certain optional operational ranges for feeding are assigned to the different skull constructions and previous hypotheses (e.g. skimming) are verified. Using the principle of economisation, these processes help to establish irreversible transformations and to define possible evolutionary pathways. The resulting constructional levels and the structural variations within these levels are interpreted in light of a greater feeding efficiency and reduction of bony mass combined with an increased stability against the various loads. The biomechanical conclusive pathways are used for comparison and verification of recent hypothesis of the phylogenetic systematics of pterosaurs.

Origin of the spin Seebeck effect

Der Spin Seebeck Effekt repräsentiert einen neuartigen Spin kalorischen Effekt mit vorteilhaften und aussichtsreichen Eigenschaften für Anwendungen in den Gebieten der Spintronik und Thermoelektrik.rnIn dieser Arbeit präsentieren wir eine umfangreiche Untersuchung des Spin Seebeck Effekts in isolierenden, magnetischen Granaten und geben Antworten zum kontrovers diskutierten Ursprung des Effekts. Um dieses Ziel zu erreichen, haben wir die Abhängigkeit des Spin Seebeck Effekts von der Dicke des Ferromagneten, der Temperatur, der Stärke des magnetisches Feldes, der Grenzflächen und des Detektormaterials, sowie Kombinationen dieser Parameter gemessen. Im Zuge dessen haben wir das Wachstum der untersuchten magnetischen Granate optimiert und eine umfassende Analyse der strukturellen und magnetischen Parameter durchgeführt, um Einflüsse der Probenqualität auszuschließen. Des Weiteren zeigte eine Untersuchung des magnetoresistiven Effekts, welcher als mögliche Ursache des Effekts galt, in Kombination mit einer Studie des Messaufbaus, dass parasitäre Einflüsse auf das Messergebnis ausgeschlossen werden können. Unsere Ergebnisse zeigen, dass der Spin Seebeck Effekt mit zunehmender Dicke des Ferromagneten eine Sättigung des Signals aufweist. Diese hängt zudem von der Temperatur ab, da mit abnehmender Temperatur die Sättigung erst bei dickeren Filmen auftritt. Außerdem fanden unsere Messungen ein Maximum des Spin Seebeck Effekts für Temperaturen unterhalb der Raumtemperatur, welcher sowohl von der Dicke des Materials als auch der Magnetfeldstärke und dem Detektormaterial beeinflusst wird. In Messungen bei hohen magnetischen Feldstärken beobachteten wir eine Unterdrückung des Messsignals, dessen Ursache mithilfe von Simulationen auf den magnonischen Ursprung des Spin Seebeck Effekts zurückgeführt werden kann. Dies unterstreicht, dass der Effekt auf vom Ferromagneten emittierten Magnonen basiert. Im letzten Abschnitt dieser Arbeit präsentieren wir Messungen in einem bislang nicht untersuchten ferrimagnetischen Material, welche zwei Vorzeichenwechsel des Spin Seebeck Effekts als Funktion der Temperatur aufzeigen. Dieses bisher unbekannte Signalverhalten betont, dass der Effekt aus einem komplexen Zusammenspiel der magnonischen Moden resultiert und zusätzlich vom Detektormaterial abhängt.rnSomit tragen unsere Ergebnisse und Beobachtungen im hohen Maße zur Beantwortung der Frage nach dem Ursprungs des Spin Seebeck Effekts bei und zeigen neuartige bisher nicht beobachtete Effekte, welche ein neues Kapitel für das Gebiet der Spin Kaloritronik eröffnen.

Thickness of softened human enamel removed by toothbrush abrasion: an in vitro study

The aim of the study was to assess the thickness of softened enamel removed by toothbrushing. Human enamel specimens were indented with a Knoop diamond. Softening was performed with citric acid or orange juice. The specimens were brushed in a brushing machine with a manual soft toothbrush in toothpaste slurry or in artificial saliva. Enamel loss was calculated from the change in indentation depth of the same indent before and after abrasion. Mean surface losses (95% confidence interval) were recorded in treatment groups (in nanometers): (1) citric acid, abrasion with slurry = 339 (280-398); (2) citric acid, abrasion with artificial saliva = 16 (5-27); (3) orange juice, abrasion with slurry = 268 (233-303); (4) orange juice, abrasion with artificial saliva = 14 (5-23); (5) no softening, abrasion with slurry = 28 (10-46). The calculated thickness of the softened enamel varied between 254 and 323 nm, depending on the acid used.

The role of the interplay between polymer architecture and bacterial surface properties on the microbial adhesion to polyoxazoline-based ultrathin films

Surface platforms were engineered from poly(L-lysine)-graft-poly(2-methyl-2-oxazoline) (PLL-g-PMOXA) copolymers to study the mechanisms involved in the non-specific adhesion of Escherichia coli (E. coli) bacteria. Copolymers with three different grafting densities (PMOXA chains/Lysine residue of 0.09, 0.33 and 0.56) were synthesized and assembled on niobia (Nb O ) surfaces. PLL-modified and bare niobia surfaces served as controls. To evaluate the impact of fimbriae expression on the bacterial adhesion, the surfaces were exposed to genetically engineered E. coli strains either lacking, or constitutively expressing type 1 fimbriae. The bacterial adhesion was strongly influenced by the presence of bacterial fimbriae. Non-fimbriated bacteria behaved like hard, charged particles whose adhesion was dependent on surface charge and ionic strength of the media. In contrast, bacteria expressing type 1 fimbriae adhered to the substrates independent of surface charge and ionic strength, and adhesion was mediated by non-specific van der Waals and hydrophobic interactions of the proteins at the fimbrial tip. Adsorbed polymer mass, average surface density of the PMOXA chains, and thickness of the copolymer films were quantified by optical waveguide lightmode spectroscopy (OWLS) and variable-angle spectroscopic ellipsometry (VASE), whereas the lateral homogeneity was probed by time-of-flight secondary ion mass spectrometry (ToF-SIMS). Streaming current measurements provided information on the charge formation of the polymer-coated and the bare niobia surfaces. The adhesion of both bacterial strains could be efficiently inhibited by the copolymer film only with a grafting density of 0.33 characterized by the highest PMOXA chain surface density and a surface potential close to zero.

An anatomical investigation of the cervicothoracic ganglion

Anatomical variability within the autonomic nervous system has long been accepted. This study evaluated the anatomical variability of the cervicothoracic ganglion (CTG) according to its form and, in addition, provided precise measurements between the CTG and the anterior tubercle of the transverse process of the sixth cervical vertebra (C6TP), the first costovertebral articulation, and the vertebral artery. Forty-two adult cadavers were dissected, 22 male and 20 females. Five main forms of CTG were documented; spindle (31.9%), dumbbell (23.2%), truncated (21.7%), perforated (14.5%), and inverted-L (8.7%). The means for length, width, and thickness of the CTG were 18.5 mm, 8.2 mm, and 4.5 mm, respectively. The dimensions were found to be slightly larger in the males than females and on the left sides as compared to the right. The mean shortest distance between the CTGs and the vertebral artery was found to be 2.8 mm, whilst the mean shortest distances to C6TP was 25.7 mm and to the first costovertebral articulation was 1.7 mm. There is great variability in the morphology of the CTG with five common forms consistently seen. The relation to the vertebral artery may influence the form of the ganglion. Two previously undocumented forms are recorded; the truncated which describes the important juxtaposition of the CTG and the vertebral artery and the perforated which describes the piercing of the ganglion itself by the artery. The findings are considered to be of clinical importance to anesthetists, surgeons, neurosurgeons, and anatomists.

Severe structural damage of the seemingly non-diseased infrarenal aortic aneurysm neck

OBJECTIVE: The success of open and endovascular repair of abdominal aortic aneurysms (AAA) is hampered by postoperative dilatation of the anatomical neck of the AAA, which is used for graft attachment. The purpose of this study was to determine whether the macroscopically non-diseased infrarenal aortic neck of AAA is histologically and biochemically altered at the time of operative repair. METHODS: We harvested full-thickness aortic wall samples as longitudinal stripes spanning from AAA neck to aneurysmal sac in 22 consecutive patients undergoing open surgical AAA repair. Control tissue was obtained from five organ donors and five deceased subjects undergoing autopsy without evidence of aneurysmal disease. We assessed aortic media thickness, number of intact elastic lamellar units, media destruction, and neovascularization grade and performed immunohistochemistry for matrix metalloproteinase (MMP)-9 and phosphorylated c-Jun N-terminal kinase (p-JNK). MMP-9 and p-JNK protein expressions were quantified using Western Blots. RESULTS: The median thickness of the aortic media was 1150 mum in control tissue (range, 1000-1300), 510 mum in aortic necks (250-900), and 200 mum in aortic sacs (50-500, P from nonparametric test for trend <.001). The number of intact elastic lamellar units was 33 in controls (range, 33-55), 12 in aortic necks (0-31) and three in aortic sacs (0-10, P < .001). The expression of MMP-9 and p-JNK as assessed by Western Blots (P = .007 and .061, respectively) and zymography (P for trend <.001) were up regulated in both the AAA neck and sac compared with controls. Except for p-JNK expression, differences between tissues were similar after the adjustment for age, gender, and type of sampling. CONCLUSION: The seemingly non-diseased infrarenal AAA neck in patients with AAA undergoing surgical repair shows histological signs of destruction and upregulation of potential drug targets.

High-resolution morphological and biochemical imaging of articular cartilage of the ankle joint at 3.0 T using a new dedicated phased array coil: in vivo reproducibility study

OBJECTIVE: The objective of this study was to evaluate the feasibility and reproducibility of high-resolution magnetic resonance imaging (MRI) and quantitative T2 mapping of the talocrural cartilage within a clinically applicable scan time using a new dedicated ankle coil and high-field MRI. MATERIALS AND METHODS: Ten healthy volunteers (mean age 32.4 years) underwent MRI of the ankle. As morphological sequences, proton density fat-suppressed turbo spin echo (PD-FS-TSE), as a reference, was compared with 3D true fast imaging with steady-state precession (TrueFISP). Furthermore, biochemical quantitative T2 imaging was prepared using a multi-echo spin-echo T2 approach. Data analysis was performed three times each by three different observers on sagittal slices, planned on the isotropic 3D-TrueFISP; as a morphological parameter, cartilage thickness was assessed and for T2 relaxation times, region-of-interest (ROI) evaluation was done. Reproducibility was determined as a coefficient of variation (CV) for each volunteer; averaged as root mean square (RMSA) given as a percentage; statistical evaluation was done using analysis of variance. RESULTS: Cartilage thickness of the talocrural joint showed significantly higher values for the 3D-TrueFISP (ranging from 1.07 to 1.14 mm) compared with the PD-FS-TSE (ranging from 0.74 to 0.99 mm); however, both morphological sequences showed comparable good results with RMSA of 7.1 to 8.5%. Regarding quantitative T2 mapping, measurements showed T2 relaxation times of about 54 ms with an excellent reproducibility (RMSA) ranging from 3.2 to 4.7%. CONCLUSION: In our study the assessment of cartilage thickness and T2 relaxation times could be performed with high reproducibility in a clinically realizable scan time, demonstrating new possibilities for further investigations into patient groups.

Composite skin grafts for basal cell carcinoma defects of the nose

Basal cell carcinoma is the most frequent cutaneous cancer of the nose and is characterized by its local spreading and exceptionally rare tendency to metastasize. Since a significant advantage has been seen in surgery compared to other treatments, surgical excision ensuring the highest chance of cure is frequently employed. Excision defects of the nose may be covered with either local flap or a full-thickness skin graft. In resurfacing such defects following excision of basal cell carcinomas, we favor the technique of composite-skin grafting which involves the harvesting of composite-skin graft including the epidermis, dermis and superficial layers of subcutaneous tissue to obtain the required thickness in the recipient site. This technique was used for defects remaining after the excision of basal cell carcinomas in a series of 15 patients. The areas involved were lateral nasal region (5 cases), nasal tip (4 cases), dorsum (3 cases), alar lobule (2 cases), and soft triangle (1 case). The mean follow-up was 14.2 months. The color, texture and thickness of the composite-skin graft harvested from the preauricular site and the neck compare favorably with the skin of the nose region. Satisfactory results, both clinically and in patient appreciation, have been obtained in both the reconstruction site and the appearance of the donor site in all patients.

Long-term cellular and regional specificity of the photoreceptor toxin, iodoacetic acid (IAA), in the rabbit retina

This study investigated the anatomical consequences of a photoreceptor toxin, iodoacetic acid (IAA), in the rabbit retina. Retinae were examined 2 weeks, 1, 3, and 6 months after systemic IAA injection. The retinae were processed using standard histological methods to assess the gross morphology and topographical distribution of damage, and by immunohistochemistry to examine specific cell populations in the retina. Degeneration was restricted to the photoreceptors and was most common in the ventral retina and visual streak. In damaged regions, the outer nuclear layer was reduced in thickness or eliminated entirely, with a concomitant loss of immunoreactivity for rhodopsin. However, the magnitude of the effect varied between animals with the same IAA dose and survival time, suggesting individual differences in the bioavailability of the toxin. In all eyes, the inner retina remained intact, as judged by the thickness of the inner nuclear layer, and by the pattern of immunoreactivity for protein kinase C-alpha (rod bipolar cells) and calbindin D-28 (horizontal cells). Müller cell stalks became immunoreactive for glial fibrillary acidic protein (GFAP) even in IAA-treated retinae that had no signs of cell loss, indicating a response of the retina to the toxin. However, no marked hypertrophy or proliferation of Müller cells was observed with either GFAP or vimentin immunohistochemistry. Thus the selective, long lasting damage to the photoreceptors produced by this toxin did not lead to a reorganization of the surviving cells, at least with survival as long as 6 months, in contrast to the remodeling of the inner retina that is observed in inherited retinal degenerations such as retinitis pigmentosa and retinal injuries such as retinal detachment.

Change of the condyle-position in maximum intercuspidation during digital, clinical occlusal analysis

Digital analysis of the occlusal contacts can be performed with the T-scan device (T Scan III, TekScan, Boston, USA). However, the thickness of the interocclusal T-scan sheet (100 μm) may lead to a displacement of the mandible. Thus, the aim of this study was to investigate the impact of the T-scan sheet on the position of the mandibular condyles in maximum intercuspidation. Twenty dentate subjects with healthy jaw function were enrolled in the study. An ultrasonic axiography device was used to measure the position of the condyles. Ten 3D condyle positions in maximum intercuspidation of the teeth were recorded: first the reference position without the sheet, then 3 times without the sheet, 3 times with the sheet, and finally again 3 times without the sheet. There was a statistically significant difference (Wilcoxon matched pairs test) between the condyle positions with and without the interocclusally positioned T-scan sheet (P < 0.0005). The T-scan device lead to a displacement of the condyles of about 1 mm mainly in ventral direction (P = 0.005). Thus, occlusal analysis is not performed in physiological, maximum intercuspidation. This has to be considered when interpreting the measured contact points.

Identification of erosional mechanisms during past glaciations based on a bedrock surface model of the central European Alps

The bedrock topography beneath the Quaternary cover provides an important archive for the identification of erosional processes during past glaciations. Here, we combined stratigraphic investigations of more than 40,000 boreholes with published data to generate a bedrock topography model for the entire plateau north of the Swiss Alps including the valleys within the mountain belt. We compared the bedrock map with data about the pattern of the erosional resistance of Alpine rocks to identify the controls of the lithologic architecture on the location of overdeepenings. We additionally used the bedrock topography map as a basis to calculate the erosional potential of the Alpine glaciers, which was related to the thickness of the LGM ice. We used these calculations to interpret how glaciers, with support by subglacial meltwater under pressure, might have shaped the bedrock topography of the Alps. We found that the erosional resistance of the bedrock lithology mainly explains where overdeepenings in the Alpine valleys and the plateau occur. In particular, in the Alpine valleys, the locations of overdeepenings largely overlap with areas where the underlying bedrock has a low erosional resistance, or where it was shattered by faults. We also found that the assignment of two end-member scenarios of erosion, related to glacial abrasion/plucking in the Alpine valleys, and dissection by subglacial meltwater in the plateau, may be adequate to explain the pattern of overdeepenings in the Alpine realm. This most likely points to the topographic controls on glacial scouring. In the Alps, the flow of LGM and previous glaciers were constrained by valley flanks, while ice flow was mostly divergent on the plateau where valley borders are absent. We suggest that these differences in landscape conditioning might have contributed to the contrasts in the formation of overdeepenings in the Alpine valleys and the plateau.

Incidence of anatomical variations and disease of the maxillary sinuses as identified by cone beam computed tomography: a systematic review.

PURPOSE To analyze available evidence on the incidence of anatomical variations or disease of the maxillary sinuses as identified by cone beam computed tomography (CBCT) in dentistry. MATERIALS AND METHODS A focused question was developed to search the electronic databases MEDLINE, EMBASE, the Cochrane Oral Health Group Trials Register, and CENTRAL and identify all relevant papers published between 1980 and January 19, 2013. Unpublished literature at ClinicalTrials.gov, in the National Research Register, and in the Pro-Quest Dissertation Abstracts and Thesis database was also included. Studies were included irrespective of language. These results were supplemented by hand and gray literature searches. RESULTS Twenty-two studies were identified. Twenty were retrospective cohort studies, one was a prospective cohort study, and one was a case control study. The main indication for CBCT was dental implant treatment planning, and the majority of studies used a small field of view for imaging. The most common anatomical variations included increased thickness of the sinus membrane, the presence of sinus septa, and pneumatization. Reported sinus disease frequency varied widely, ranging from 14.3% to 82%. There was a wide range in the reported prevalence of mucosal thickening related to apical pathology, the degree of lumenal opacification, features of sinusitis, and the presence of retention cysts and polyps. More pathologic findings in the maxillary sinus were reported in men than in women, and the medial wall and sinus floor were most frequently affected. CONCLUSION CBCT is used primarily to evaluate bony anatomy and to screen for overt pathology of the maxillary sinuses prior to dental implant treatment. Differences in the classification of mucosal findings are problematic in the consistent and valid assessment of health and disease of the maxillary sinus.