Development of High-Intensity Focused Ultrasound Therapy for Inferior Turbinate Hypertrophy

Objectives@#. Inferior turbinate (IT) hypertrophy is the main cause of chronic nasal obstruction. We developed a high-intensity focused ultrasound (HIFU) ablation device to treat patients with IT hypertrophy. @*Methods@#. First, computed tomography images of patients with no evidence of sinonasal disease were evaluated to measure and compare the IT, medial mucosal thickness (MT), and space between the nasal septum and IT according to clinical characteristics such as septal deviation. A HIFU prototype was developed based on the above human anatomical studies. The experimental study was performed in five pigs; the nasal volume and histological changes at 1 and 4 weeks postoperatively were evaluated to compare the efficacy of HIFU turbinoplasty with that of radiofrequency turbinoplasty and a control group. @*Results@#. The mean medial MT of the anterior, middle, and posterior portions of the IT were 4.66±1.14, 4.23±0.97, and 6.17±1.29 mm, respectively. The mean medial space was 2.65±0.79 mm. The diameter and focal depth of the prototype were 4 mm and 3 mm, respectively. HIFU showed no postoperative complications, including bleeding or scar formation. After HIFU treatment, the nasal volume increased by 196.62 mm3 (7.8%) and 193.74 mm3 (8.3%) at 1 week and 4 weeks, compared with the increase of 87.20 mm3 (3.1%) and 213.81 mm3 (9.0%), respectively,after radiofrequency therapy. A qualitative histological analysis after radiofrequency turbinoplasty showed epithelial layer disruption at 1 week and increased fibrosis, along with decreased glandular structure, at 4 weeks. The HIFU group had an intact epithelial layer at 1 week postoperatively. However, significant differences were observed at 4 weeks, including increased fibrosis and decreased glandular structure. @*Conclusion@#. The efficacy and safety of HIFU turbinoplasty were demonstrated in an animal study. Our results warrant further human clinical trials.

Characteristics of Obstructive Sleep Apnea Patients With a Low Body Mass Index: Emphasis on the Obstruction Site Determined by Drug-Induced Sleep Endoscopy

Objectives@#. This study aimed to elucidate the patterns of upper airway collapse in obstructive sleep apnea (OSA) patients with a low body mass index (BMI). @*Methods@#. We designed and conducted a retrospective cohort study. Consecutive patients diagnosed with OSA who underwent drug-induced sleep endoscopy (DISE) were included. Patients were classified into four groups according to their BMI. Age, sex, and polysomnography data were investigated. The patterns of upper airway collapse were characterized by the structures involved (soft palate, tongue base, lateral pharyngeal wall, and epiglottis). We compared the patterns of upper airway collapse in the supine and lateral decubitus position among the four BMI groups using the chi-square test and multivariate binary logistic regression analysis. @*Results@#. A total of 627 patients (male, 517; mean age, 47.6±12.8 years) were included, consisting of 45, 79, 151, and 352 patients who were underweight or lower normal-weight (defined as the low BMI group), upper normal-weight, overweight, and obese, respectively. Severity indicators of OSA, such as the overall apnea-hypopnea index and duration of SaO2 below 90%, were significantly lower in patients with a low BMI than in obese patients, while their average oxygen saturation was significantly higher. The most common obstruction site in the supine position was the tongue base in patients with a low BMI (100%), whereas this obstruction site was significantly less common in obese patients (54.8%). Tongue base obstruction was mostly relieved in the lateral position, with no discernible obstruction in 86.7% of the low BMI patients. @*Conclusion@#. Airway obstruction in OSA patients with a low BMI is mostly due to tongue base obstruction, which improves in the lateral position. These characteristics should be kept in mind when considering treatment options for this subgroup of OSA patients.

Principal Clinical Factors Predicting Therapeutic Outcomes After Surgical Drainage of Postoperative Cheek Cysts: Experience From a Single Center

OBJECTIVES: Postoperative cheek cyst (POCC) is a late postoperative complication of radical maxillary sinus surgery including the Caldwell-Luc (C-L) operation. The present study aimed to evaluate the therapeutic outcomes of surgical treatment for POCC and to assess the clinical factors correlated to these outcomes. METHODS: This study included 57 patients (67 nostrils) diagnosed with POCC who underwent surgical drainage. The medical records of the patients were retrospectively reviewed for radiological findings, treatment modalities, residual symptoms, and recurrences. RESULTS: In total, 30 patients were male and 27 patients were female with a mean age of 55 years, and the patients were usually diagnosed with POCC 28.2 years after radical surgery. Endonasal endoscopic marsupialization was performed via inferior meatal antrostomy, and if possible, middle meatal antrostomy was performed at the same time. In patients with cysts that were difficult to reach using an endonasal endoscopic approach, additional open C-L approaches were performed. The median follow-up period was 19.4 months. Overall, adequate drainage and symptomatic relief were achieved in 91% (61/67) of the patients. The recurrence rate was significantly higher in patients who had anterolateral POCC. Failure to achieve symptomatic relief was correlated to a smaller cyst and the use of the open C-L approach for drainage. CONCLUSION: The location and size of the cyst as well as the use of the open surgical approach were important factors in predicting the therapeutic outcome of POCC. The time point of treatment and surgical approaches should be based on the above-mentioned findings.

TRAPR: R Package for Statistical Analysis and Visualization of RNA-Seq Data

High-throughput transcriptome sequencing, also known as RNA sequencing (RNA-Seq), is a standard technology for measuring gene expression with unprecedented accuracy. Numerous bioconductor packages have been developed for the statistical analysis of RNA-Seq data. However, these tools focus on specific aspects of the data analysis pipeline, and are difficult to appropriately integrate with one another due to their disparate data structures and processing methods. They also lack visualization methods to confirm the integrity of the data and the process. In this paper, we propose an R-based RNA-Seq analysis pipeline called TRAPR, an integrated tool that facilitates the statistical analysis and visualization of RNA-Seq expression data. TRAPR provides various functions for data management, the filtering of low-quality data, normalization, transformation, statistical analysis, data visualization, and result visualization that allow researchers to build customized analysis pipelines.

Radiographic Changes of the Nasal Septal Body Among Patients With Sinonasal Diseases

OBJECTIVES: This study aims to determine the anatomical changes occurring in the nasal septal body (NSB) among patients with sinonasal disease and compares the measurements obtained from patients without sinonasal disease. METHODS: This was a retrospective study involving review of 405 (93 without and 212 with sinonasal disease) plain paranasal sinus computed tomography (PNS CT) on coronal view at a tertiary training hospital, which was done consecutively from January 2014 to December 2015. NSB measurements from 3 areas were done: anterior part (A), located anterior and superior to inferior turbinate; middle or widest (M) part, located anterior to middle turbinate and superior to inferior turbinate and posterior (P) part, located within the anterior 1/3 of middle turbinate not going beyond the crista galli. Posterior part of septum (sP) was measured at the area of horizontal attachment of middle turbinate to the lateral nasal wall and superior turbinate to represent the less vasoactive part of the septum. Demographic data and NSB diameters were also analyzed. RESULTS: The mean NSB diameter measurements were significantly larger among the diseased group (disease vs. control; A: 6.88 mm vs. 5.92 mm, P=0.001; M: 12.74 mm vs. 10.47 mm, P=0.001; P: 8.35 mm vs. 6.79 mm, P=0.001). A similar observation in sP part (3.35 mm vs. 2.54 mm, P=0.014) was noted. When grouped by age, among the control group, older subjects had considerable decrease in NSB size in all points of measurements except for sP (P>0.05). Such reduction in size is noticeable for those in their 4th, 5th, 6th, and 7th decades of life. For the diseased group, a trend of increasing NSB and sP size was noted as the subjects are getting older. However, only the anterior part (A) of NSB reached statistical significance (P=0.016). CONCLUSION: With aging we expect nasal mucosal atrophy among normal subjects. However, patients with chronic sinonasal disease showed thickened nasal mucosa. Further study for the reversibility of thickened mucosa is needed.

Correlation between Tinnitus Induced Distress and Sleep Quality / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There exist few studies about relationship between tinnitus and sleep disturbance. Furthermore, the currently available studies have some limitations of confounding factors. This study evaluated correlation between tinnitus and sleep quality, especially by controlling depression and anxiety factors. SUBJECTS AND METHOD: The present study was planned as a cross sectional study using questionnaires. Using 46 patients with tinnitus, sleep quality was investigated by Pittsburgh Sleep Quality Index (PSQI) score, anxiety by State-Trait Anxiety Inventory (STAI, axis1 and axis2), depression by Beck Depression Inventory (BDI), and tinnitus induced distress by Tinnitus Handicap Inventory (THI). The final analysis method was multiple regression analysis. THI and PSQI were regarded as dependent and independent variables, respectively. BDI and STAI were regarded as confounding factors. RESULTS: Each factor (PSQI, two STAI, and BDI) revealed significant correlation with THI score. Considering four factors together with regression analysis, PSQI score was the most influencing factor on THI score (p=0.002). CONCLUSION: Although depression and anxiety were both influencing factors on tinnitus-induced distress as known previously, sleep quality influenced tinnitus-induced distress came out as the most significant factor in the multivariable analysis.

A Case of Tracheal Foreign Body Removed by Endoscopic Approach with Tracheotomy / 대한이비인후과학회지

Foreign body (FB) airway obstruction is a life-threatening clinical situation. The FB's are removed by bronchoscopy in the majority of patients, but in highly-selected cases, tracheotomy is occasionally indicated in foreign body extraction, when they are subglottic in location and impacted, or large enough to get obstructed at the glottic chink during endoscopic removal. Authors report one case of tracheal FB which required tracheotomy for the FB removal after the failure of FB removal with rigid bronchoscopy.

Identification of Proteins Induced at Hypoxic and Low pH Conditions in Mycobacterium tuberculosis H37Rv

Mycobacterium tuberculosis likely reside within a granuloma as a dormant state. An area of necrosis forms at the center of lung granulomas. Within this area, the bacteria are deprived of nutrients and exposed to harsh conditions, including low pH and anoxia. The response of M. tuberculosis to low pH and low oxygen conditions was investigated in both cellular and extracellular proteins by two-dimensional polyacrylamide gel electrophoresis analysis and MALDITOF. Several proteins intensively expressed under low pH and/or hypoxic conditions were found. In the culture filtrate, PhoS1 (Rv0934) and ScoB (Rv2503c) were found in significant amounts under both the low oxygen and acidic stress conditions. These results indeed extend our understanding of acidic response as well as hypoxic in M. tuberculosis and provide an important insight into physiology of the latent bacilli.

Detection of HBV in Blood and Blood Products by PCR

The aim of this study was to establish a PCR for detecting of the hepatitis B virus (HBV) in blood and blood products. A primer pair set was designed to amplify a 513 bp fragment in the S-region of the HBV genome in the first PCR and a 233 bp fragment of first PCR amplicon in the second PCR with Rubisco (internal control). In order to assess the specificity of the PCR results, all the samples were tested cross-reactivity or interference in the assay. This method did not result in cross-reactivity with the non-HBV (HAV, HCV, HIV, CMV, HPV 18&6b, parvovirus B19/ or HSV 1&2) positive samples and was unaffected. In case of the HBV spiked blood products such as the immunogloubulin and coagulation factors, the lower detection limit of this method for the HBV DNA is 62.5 IU/ml. The PCR method is fully established in this study and will be a valuable method for the detection of the HBV in a variety of blood products, particularly, those derived from starting materials with a high titer of virus.

Role of Mitogen-Activated Protein Kinase Pathways in the Production of TNF-alpha, IL-10, and MCP-1 by Mycobacterium tuberculosis H37Rv-Infected Human Blood Monocytes

Clinical manifestations of tuberculosis are closely associated with the initial responses of macrophages to mycobacteria. In this study, we investigated the signal transduction pathways for the secretion of cytokines and chemokines [tumor necrosis factor (TNF)-alpha, interleukin (IL)-10, IL-8, and monocyte chemotactic protein-1 (MCP-1)] in human blood monocytes infected with Mycobacterium tuberculosis H37Rv. M. tuberculosis H37Rv infection induced the secretion of significant amounts of TNF-alpha, IL-10, IL-8, and MCP-1 from human blood monocytes. Analysis of mitogen-activated protein kinase (MAPK) activation [extracellular signal-regulated kinase 1/2 (ERK) and p38 kinase] showed rapid phosphorylation of both subfamilies in response to M. tuberculosis H37Rv. Using highly specific inhibitors of p38 (SB203580) and of MEK-1 (U0126 and PD98059), we found that both p38 and ERK were essential for M. tuberculosis H37Rv-induced TNF-alpha production, whereas activation of the p38 pathway, but not that of ERK, was essential for M. tuberculosis H37Rv-induced IL-10 production. Interestingly, the ERK pathway, but not that of p38, was critical for MCP-1 secretion from human blood monocytes infected with M. tuberculosis H37Rv. However, IL-8 secretion was regulated neither by ERK1/2 nor p38 MAPK. Collectively, these results suggest that induction of the MAPK pathway is required for the expression of TNF-alpha. IL-10, and MCP-1 by human blood monocytes during M. tuberculosis H37Rv infection.

Depression of Both Interferon-gamma and Tumor Necrosis Factor-alpha Production by Peripheral Blood Mononuclear Cells from Chronic Refractory Tuberculosis Patients

Understanding human immune responses in chronic refractory tuberculosis (CRTB) is important for developing immunotherapy against the disease. The aim of this study was to examine cytokine responses [interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-10] by peripheral blood mononuclear cells (PBMCs) in CRTB patients after in vitro stimulation with the 30-kDa or purified protein derivative (PPD) antigen (Ag). Most of the CRTB cases were multidrug-resistant (MDR) TB. The results were compared with those from early TB (E-TB) patients and healthy tuberculin reactors (HTR). IFN-gamma production was significantly depressed in both CRTB and E-TB groups compared with HTR. In response to the 30-kDa Ag, TNF-alpha levels were significantly depressed only in CRTB patients, while greatly increased in E-TB patients. In addition, IL-10 production was significantly increased in E-TB patients, and PBMC from both E-TB and CRTB patients secreted more IL-6 than HTR. IL-10 neutralization significantly increased TNF-alpha levels, whereas anti-TNF-alpha did not alter IL-10 induction significantly in PBMC from HTR and CRTB patients. Our findings suggest that CRTB patients have depression in both IFN-gamma and TNF-alpha reponses, which might play important roles during chronic M. tuberculosis infection.

Twin Pregnancies: In Vitro Fertilization vs. Spontaneously Conceived / 대한산부인과학회잡지

OBJECTIVE: To compare the obstetrical and perinatal outcomes of twin pregnancies after IVF-ET with those of twin pregnancies conceived spontaneously. METHODS: Two hundred and six cases of IVF-ET twin pregnancies (IVF group) were compared with 229 spontaneously conceived or ovulation induced twin pregnancies (spontaneously conceived group) for obstetrical and perinatal outcomes. All were delivered between July 1994 and February 2002 at Ajou University Hospital. Their clinical records were reviwed. RESULTS: The mean maternal age of IVF group and spontaneously conceived group was 30.7+/-3.7 years, 28.4+/-4.0 years and primiparous women were 86.9%, 58.5% (p=0.000). In IVF group and spontaneously conceived group, mean gestational age was 35.0+/-1.7 weeks, 35.5+/-2.1 weeks (P=0.000), mean birth weight 2311.4+/-411.7 gm, 2324.3+/-447.1 gm (P=0.015), and frequency of birth weight less than 2500 gm 70.6%, 60.3% (p=0.001). In both groups, the frequencies for preterm labor, preeclampsia, intrauterine growth restriction, and birth weight discordancy were 42.2%, 32.3% (p=0.032), 8.3%, 18.3% (p=0.002), 5.3%, 8.7% (p=0.052%), 7.8%, 10.9% (p=0.262), respectively. On the comparison of the chorionicity, monochorion- diamnion was 2.0%, 36.3% (p=0.000) and dichorion-diamnion was 98.0%, 62.8% (p=0.000). And there was no significant difference in congenital anomaly, Apgar scores, frequency and duration of neonatal intensive care unit admission. CONCLUSION: In IVF-ET twin group compared with spontaneously conceived group, there was higher incidence of preterm labor, and low birth weight.

IL-12 and TNF-alpha productions from human peripheral blood mononuclear cells in untreated patients with active pulmonary tuberculosis stimulated with 30-kDa or TSP antigen of Mycobacterium tuberculosis H37Rv

No abstract available.

Increased IL-12 , but Depressed IL-18 Production after In Vitro Stimulation with a 30-kDa Mycobacterial Antigen in Tuberculous Pleural Mononuclear Cells

In this study, we investigated interleukin (IL)-18 and IL-12 following in vitro stimulation with either the 30-kDa or purified protein derivative (PPD) antigens (Ag) of pleural mononuclear cells from 12 cases of tubercular pleurisy (TB-PMC) and 8 cases of malignant pleurisy (MG-PMC). Ag-stimulated TB-PMC produced significantly more IL-12 than did MG-PMC and the levels correlated with those of IFN - gamma. Although elevated IL-18 levels were found in freshly isolated pleural fluids, in vitro IL-18 production in response to either Ag was dramatically decreased in TB-PMC. Pro-IL-18 mRNA was detected before and after Ag stimulation in TB patients. Supernatants from the Ag-stimulated TB-PMC significantly suppressed IL-18 production in normal peripheral blood mononuclear cells (PBMC) and primary malignant cells over an 18 h incubation period. In addition, this suppressive activity was not inactivated by either heat or trypsin. Our findings imply that modulation of IL-12 and IL-18 levels may contribute to the Th1 elevation induced in human TB-P VIC by the 30-kDa and PPD antigens.

Purification and Partial Characterization of the 38 kDa Glycolipoprotein Antigen from the Culture Filtrate of Mycobacterium tuberculosis H37Rv

Mycobacterium tuberculosis infected macrophages can become ineffective at activating CD4+ T cells through presentation of peptide antigens by MHC class II, possibly contributing to the ability of M tuberculosis to persist despite the presence of an intact immune system. Presentation of lipid antigens may help to overcome this problem. CD1 represents the key component of an MHC independent pathway for presentation nonpeptide lipid antigens to T cells. The 38 kDa glycolipoprotein antigen of M. tuberculosis is actively secreted. The antigen induces strong antibody and T-cell responses and provided partial protection against M. tuberculosis infection in mice when it is administered either entrapped in biodegradable microparticles or in the form of a DNA vaccine. But an selective anergy to stimulation with peptide of the 38 kDa was observed in the majority of tuberculosis patients. An 38 kDa antigen has been isolated by affinity chromatography using a monoclonal antibody. This antigen contains some immunosuppressive cell wall associated antigens such as lipoarabinomannan. Therefore, we purified the 38 kDa glycolipoprotein from the culture filtrate of M tuberculosis H37Rv by ammonium sulfate precipitation (55~80%), hydroxylapatite and DEAE-Sephacel column. The purified antigen showed three major bands on isoelectric focusing gel, and two-dimensional electrophoresis (2-DE) analysis of this antigen revealed five distinct spots of the 38 kDa molecular mass. One of five spots had a N-terminal sequence identical to that of the 38 kDa glycolipoprotein (pstS-1). Other protein spots could not determine sequences. An antiserum against the recombinant 38 kDa antigen of M tuberculosis reacted strongly with the purified the 38 kDa antigen.

Efficacy of Conization in Patients with Cervical Intraepithelial Neoplasia / 대한산부인과학회잡지

OBJECTIVES: The objective of this study is to evaluate the efficacy of conization of the cervix in patients with cervical intraepithelial neoplasia. STUDY DESIGN: Cold-Knife conization was performed in total 436 patients from June 1994 to May 2000. Indications and complications of conization were studied. And the results of cervical cytology, cervical histology, colposcopic findings and pathologic diagnosis of conization specimens were evaluated in comparison with the pathologic diagnosis of hysterectomy specimens and follow-up check of the patients. RESULTS: Followings are results summarized. 1. Patients distribution according to cone biopsy results was 31.0% for CIS, 43.3% for CIN III, 14.7% for CIN II, 7.6% of CIN I, 3.4% for CNI, respectively. 2. The rate of agreement between colposcopy-directed biopsy and conization was 63.1%. 3. The positive rate of resection margin was 15.1%. 4. The recurrence rate in clear resection margin group was 7.0%. But there was no recurrence after hysterectomy in cases with positive resection margin of conization specimen, and the recurrence rate of positive resection margin without hysterectomy group was 10.5%. 5. The incidence of delayed hemorrhage (bleeding after 2 weeks) in hemostatic suture group and electric cauterization only group was 4.7% (13/279) and 15.6% (23/157), respectively. CONCLUSION: We conclude that conization of the cervix as the surgical treatment was effective in CIN patients with careful patient selection.

Clinical outcomes of pregnancy showing one abnormal glucose tolerance test value / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical outcomes of pregnancies showing one abnormal glucose tolerance test value. Method: We performed 50 gm glucose challenge test in 5,019 pregnant women at 24-28 weeks of gestation. In 1,170 women with plasma glucose levels over 130 mg/dL, 100 gm oral glucose tolerance tests (OGTTs) were performed at 28-32 weeks of gestation. In the 888 cases who were followed up, according to the National Diabetes Data Group (NDDG) criteria, 122 cases with one abnormal 100 gm OGTT value were divided into three groups (groups 1, 2, 3 : abnormal value after 1, 2, 3 hours, respectively). These were compared with 577 cases (control group) with normal 100 gm OGTT value, retrospectively. Result: The incidence of one abnormal glucose tolerance test value was 2.6%, and there were no cases where the fasting plasma glucose level only was elevated. The incidence (control, group 1, group 2, group 3 : 19.4%, 43.8%, 25.7%, 29.6%) of poor maternal outcomes which contain any one of preeclampsia, hydramnios, cesarean delivery for cephalopelvic disproportion or failure to progress or fetal distress was highest in group 1 (p=0.025). The incidence (15.8%, 43.1%, 14.3%, 21.1%) of poor perinatal outcomes which contain any one of fetal distress, Apgar score of 5 minute < 7, hypoglycemia, respiratory distress syndrome, small for gestational age, perinatal death was also highest in group 1 (p=0.009). Logistic regression analysis for poor maternal outcomes showed odds ratio of 2.83 (95% confidence interval 1.02-7.87) in group 1 and 2.08 (95% confidence interval 1.22-3.55) in group 3, and for poor perinatal outcomes odds ratio of 4.24 (95% confidence interval 1.02-17.52) in group 1 and 3.30 (95% confidence interval 1.45- 7.48) in group 3. CONCLUSION: Pregnancies complicated with one abnormal glucose tolerance test value, particularly the group showing abnormal glucose tolerance test value after 1 or 3 hour exhibited adverse maternal and perinatal outcomes.

A case of acute disseminated encephalomyelitis with liver abscess / 대한내과학회지

Acute disseminated encephalomyelitis (ADEM) is an acute inflammatory demyelinating disease of central nervous system, and is related to allergic or immune-mediated reaction to systemic viral infection or vaccination, which is usually self limited monophasic illness. As the clinical manifestations or laboratory findings is nonspecific, it is diagnosed by brain magnetic resonance imaging (MRI) showing multiple foci of increased T2 signal within white matter. We report the clinical and radiologic imaging findings in a 36-year-old man in whom acute disseminated encephalomyelitis developed after serologically proven herpes infection combined with liver abscess. His clinical course, despite without corticosteroid or plasmapheresis because of liver abscess, was shown spontaneous remission.

Increased IL-12 and Interferon-Hamma, But Not IL-18 Production, After In Vitro Stimulation with a 30-kDa Mycobacterial Antigen in Patients with Tuberculous Pleurisy

No Abstract Available.

Cloning and Expression of Low Molecule Protein Antigens from Mycobacterium tuberculosis H37Rv

No Abstract Available.