ABSTRACT
Background and Objectives@#The aim of this study was to compare adherence to positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA) of different severity.Subjects and Method We conducted a retrospective study including 270 adult OSA patients who used a PAP device for at least 3 months. We assessed the percentage of days on which the device was used, the percentage of days on which the device was used for ≥4 h, and the average duration of PAP device usage at 12 weeks of PAP therapy. We also evaluated adequate adherence to PAP therapy using a PAP device for ≥4 h/day and during ≥70% of nights. @*Results@#The percentage of days on which a PAP device used did not differ significantly according to OSA severity (median [Q1-Q3]; mild: 91.40% [81.25%-97.65%], moderate: 94.50% [86.90%-100%], severe: 95.90% [88.10%-100%], p=0.268). We also found that the percentage of days on which a PAP device was used during sleep for ≥4 h was not significantly different in patients with different OSA severity (median [Q1-Q3], mild: 76.20% [69.70%-89.90%], moderate: 89.30% [67.65%-95.70%], severe: 85.70% [75.85%-95.45%], p=0.097). The percentage of patients with adequate PAP adherence did not differ significantly according to OSA severity (mild: 74.2%, moderate: 72.1%, severe: 83.0%, p=0.084). Moreover, the mean duration (minutes) of PAP device usage during sleep did not differ significantly according to OSA severity in the mild, moderate, and severe OSA groups (mean±standard deviation, mild: 348.03± 47.78 min, moderate: 358.58±85.22 min, severe: 363.79±57.21 min, p=0.440). @*Conclusion@#Adherence to PAP therapy did not differ significantly according to OSA severity. Therefore, it is necessary to continuously expand and maintain the insurance for health promotion in OSA patient in South Korea.
ABSTRACT
Thyroid tuberculosis with papillary thyroid carcinoma is very rare. The current study shows the case of a 67-year-old female who was admitted to Ansan Hospital of Korea University, with her thyroid nodules showing signs of malignancy under ultrasonography. A histopathological examination proved the coexistence of papillary thyroid carcinoma (PTC) and thyroid tuberculosis (TB). A total thyroidectomy and excision of the enlarged left neck level II lymph node were performed. This report presents a rare case of coexistence of PTC and thyroid TB. Further investigation is needed to evaluate the possible role of PTC in thyroid mycobacterial infection.
ABSTRACT
Thyroid tuberculosis with papillary thyroid carcinoma is very rare. The current study shows the case of a 67-year-old female who was admitted to Ansan Hospital of Korea University, with her thyroid nodules showing signs of malignancy under ultrasonography. A histopathological examination proved the coexistence of papillary thyroid carcinoma (PTC) and thyroid tuberculosis (TB). A total thyroidectomy and excision of the enlarged left neck level II lymph node were performed. This report presents a rare case of coexistence of PTC and thyroid TB. Further investigation is needed to evaluate the possible role of PTC in thyroid mycobacterial infection.
ABSTRACT
Background and Objectives@#Vitamin D modulates immunity, including that of allergic diseases, and plays its roles through contact with vitamin D receptors (VDR). Recent studies have shown that patients with allergic rhinitis have low systemic serum vitamin D level. However, the expression of VDR in local tissue such as human nasal mucosa has not been investigated. Our study demonstrated that, in nasal mucosa of normal controls and patients with allergic rhinitis. @*Materials and Methods@#Nasal mucosa were harvested from twenty-five patients who had normal nasal mucosa and twenty-five patients with allergic rhinitis. After the total RNA isolation, we performed reverse transcriptase-polymerase chain reaction, immunohistochemical staining and western blot analysis. @*Results@#VDR were expressed in submucosal glands and the superficial layer of epithelial cell, and that inflammatory cells are expressed more highly in the nasal mucosa of patients with allergic rhinitis compared to those without. In the mucosa of patients with allergic rhinitis, VDR expression level was upregulated compared to that in normal nasal mucosa. @*Conclusion@#This findings suggest that VDR plays a role in the pathogenesis of allergic rhinitis. Additional research is needed to determine the mechanism and consequences of VDR upregulation.
ABSTRACT
Patients with tracheoesophageal fistula show signs of aspiration, possibly leading to pneumonia, which could be fatal to bed-ridden patients. Tracheoesophageal fistula occurs as a complication of intubation, tracheostomy tube insertion and nasogastric tube insertion. Possible etiology is pressure and ischemic necrosis given by tracheostomy tube and nasogastric tube to trachea and esophagus; or in some cases, larynx and hypopharynx. Meanwhile, for repair of tracheoesophageal fistula, transcervical approach can be considered but takes relatively long operation time and is not appropriate for patients with underlying diseases. We report a case of tracheoesophageal fistula complicated several years after tracheostomy tube and nasogastric tube insertion who came to medical attention with signs of aspiration. Authors successfully performed repair of the fistula under laryngeal microsurgery approach without skin incision and dissection, and thereby report the experience with review of literature.
ABSTRACT
Objectives@#. Prognosticating idiopathic sudden sensorineural hearing loss (ISSNHL) is an important challenge. In our study, a dataset was split into training and test sets and cross-validation was implemented on the training set, thereby determining the hyperparameters for machine learning models with high test accuracy and low bias. The effectiveness of the following five machine learning models for predicting the hearing prognosis in patients with ISSNHL after 1 month of treatment was assessed: adaptive boosting, K-nearest neighbor, multilayer perceptron, random forest (RF), and support vector machine (SVM). @*Methods@#. The medical records of 523 patients with ISSNHL admitted to Korea University Ansan Hospital between January 2010 and October 2017 were retrospectively reviewed. In this study, we analyzed data from 227 patients (recovery, 106; no recovery, 121) after excluding those with missing data. To determine risk factors, statistical hypothesis tests (e.g., the two-sample t-test for continuous variables and the chi-square test for categorical variables) were conducted to compare patients who did or did not recover. Variables were selected using an RF model depending on two criteria (mean decreases in the Gini index and accuracy). @*Results@#. The SVM model using selected predictors achieved both the highest accuracy (75.36%) and the highest F-score (0.74) on the test set. The RF model with selected variables demonstrated the second-highest accuracy (73.91%) and F-score (0.74). The RF model with the original variables showed the same accuracy (73.91%) as that of the RF model with selected variables, but a lower F-score (0.73). All the tested models, except RF, demonstrated better performance after variable selection based on RF. @*Conclusion@#. The SVM model with selected predictors was the best-performing of the tested prediction models. The RF model with selected predictors was the second-best model. Therefore, machine learning models can be used to predict hearing recovery in patients with ISSNHL.
ABSTRACT
Patients with tracheoesophageal fistula show signs of aspiration, possibly leading to pneumonia, which could be fatal to bed-ridden patients. Tracheoesophageal fistula occurs as a complication of intubation, tracheostomy tube insertion and nasogastric tube insertion. Possible etiology is pressure and ischemic necrosis given by tracheostomy tube and nasogastric tube to trachea and esophagus; or in some cases, larynx and hypopharynx. Meanwhile, for repair of tracheoesophageal fistula, transcervical approach can be considered but takes relatively long operation time and is not appropriate for patients with underlying diseases. We report a case of tracheoesophageal fistula complicated several years after tracheostomy tube and nasogastric tube insertion who came to medical attention with signs of aspiration. Authors successfully performed repair of the fistula under laryngeal microsurgery approach without skin incision and dissection, and thereby report the experience with review of literature.