Ovastacin: An oolemma protein that cleaves the zona pellucida to prevent polyspermy / 대한생식의학회지

Monospermy occurs in the process of normal fertilization where a single sperm fuses with the egg, resulting in the formation of a diploid zygote. During the process of fertilization, the sperm must penetrate the zona pellucida (ZP), the outer layer of the egg, to reach the egg’s plasma membrane. Once a sperm binds to the ZP, it undergoes an acrosomal reaction, which involves the release of enzymes from the sperm’s acrosome that help it to penetrate the ZP. Ovastacin is one of the enzymes that is involved in breaking down the ZP. Studies have shown that ovastacin is necessary for the breakdown of the ZP and for successful fertilization to occur. However, the activity of ovastacin is tightly regulated to ensure that only one sperm can fertilize the egg. One way in which ovastacin helps to prevent polyspermy (the fertilization of an egg by more than one sperm) is by rapidly degrading the ZP after a sperm has penetrated it. This makes it difficult for additional sperm to penetrate the ZP and fertilize the egg. Ovastacin is also thought to play a role in the block to polyspermy, a mechanism that prevents additional sperm from fusing with the egg’s plasma membrane after fertilization has occurred. In summary, the role of ovastacin in monospermic fertilization is to help ensure that only one sperm can fertilize the egg, while preventing polyspermy and ensuring successful fertilization.

Decorin: a multifunctional proteoglycan involved in oocyte maturation and trophoblast migration / 대한생식의학회지

Decorin (DCN) is a proteoglycan belonging to the small leucine-rich proteoglycan family. It is composed of a protein core containing leucine repeats with a glycosaminoglycan chain consisting of either chondroitin sulfate or dermatan sulfate. DCN is a structural component of connective tissues that can bind to type I collagen. It plays a role in the assembly of the extracellular matrix (ECM), and it is related to fibrillogenesis. It can interact with fibronectin, thrombospondin, complement component C1, transforming growth factor (TGF), and epidermal growth factor receptor. Normal DCN expression regulates a wide range of cellular processes, including proliferation, migration, apoptosis, and autophagy, through interactions with various molecules. However, its aberrant expression is associated with oocyte maturation, oocyte quality, and poor extravillous trophoblast invasion of the uterus, which underlies the occurrence of preeclampsia and intrauterine growth restriction. Spatiotemporal hormonal control of successful pregnancy should regulate the concentration and activity of specific proteins such as proteoglycan participating in the ECM remodeling of trophoblastic and uterine cells in fetal membranes and uterus. At the human feto-maternal interface, TGF-β and DCN play crucial roles in the regulation of trophoblast invasion of the uterus. This review summarizes the role of the proteoglycan DCN as an important and multifunctional molecule in the physiological regulation of oocyte maturation and trophoblast migration. This review also shows that recombinant DCN proteins might be useful for substantiating diverse functions in both animal and in vitro models of oogenesis and implantation.

Recognition of lipopolysaccharide pattern by TLR4 complexes

Lipopolysaccharide (LPS) is a major component of the outer membrane of Gram-negative bacteria. Minute amounts of LPS released from infecting pathogens can initiate potent innate immune responses that prime the immune system against further infection. However, when the LPS response is not properly controlled it can lead to fatal septic shock syndrome. The common structural pattern of LPS in diverse bacterial species is recognized by a cascade of LPS receptors and accessory proteins, LPS binding protein (LBP), CD14 and the Toll-like receptor4 (TLR4)-MD-2 complex. The structures of these proteins account for how our immune system differentiates LPS molecules from structurally similar host molecules. They also provide insights useful for discovery of anti-sepsis drugs. In this review, we summarize these structures and describe the structural basis of LPS recognition by LPS receptors and accessory proteins.

Diagnostic Value of C-reactive Protein in Complicated Appendicitis

PURPOSE: Early detection of appendicitis has increased due to development of computed tomography and ultrasonography, yet we are frequently meeting complicated appendicitis, including perforation, abscess and a gangrenous appendicitis due to delayed diagnosis. For that reason, we want to evaluate predictive factors for the complicated appendicitis. METHODS: A total of 128 patients with appendicitis, after 13 patients with a duration of under 12 hours and 15 patients with pathological non-appendicitis were excluded from 156 patients, who visited Kwangju Christian Hospital from November 2008 to November 2010 were retrospectively reviewed. RESULTS: There were 62 patients (48.3%) with simple appendicitis and 66 patients (51.7%) with complicated appendicitis. In univariate analysis, age (P < 0.001), C-reactive protein (P < 0.001) and the diameter of the appendix (P = 0.006), were found to be significant. Multivariate analysis demonstrated that C-reactive protein was an independent predictor for complicated appendicitis (odds ratio, 1.371; 95% confidence interval, 1.155 to 1.628; P < 0.001). The cut-off value of C-reactive protein was set at 7.05 mg/dL by using receiver operating characteristic curve (0.805; sensitivity, 57.6%; specificity, 98.3%). CONCLUSION: This study suggests that if C-reactive protein is above 7.05 mg/dL, immediate and proper management should be performed due to a high probability of complicated appendicitis, especially in young children or elderly patients who frequently present with vague symptoms.

Ectopic Eruption of a Tooth into the Nasal Cavity with Sinusitis: A Case Report

The ectopic eruption of teeth into the nasal cavity is a rare phenomenon. Ectopic tooth eruptions commonly occur in the palate and maxillary sinus, but have also been reported in the mandibular condyle, coronoid process, orbit, and nasal cavities. The clinical manifestations of intranasal teeth are quite variable; however, intranasal teeth can be an incidental finding during routine examination in patients without nasal discomfort. Herein we report a unique case of an intranasal ectopic tooth that erupted into the nasal cavity and caused significant nasal symptoms in an otherwise healthy patient. The intranasal tooth was removed endoscopically.

The Improvement of Tongue Mobility and Articulation after Frenotomy in Patient with Ankyloglossia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ankyloglossia, manifested by the short and lingual frenulum, can affect tongue mobility and articulation. The purpose of this study is to evaluate the improvement of tongue mobility and articulation in patients with akyloglossia, which is treated by frenotomy. SUBJECTS AND METHOD: A prospective study was done for 81 patients with ankyloglossia undergoing frenotomy, and who were aged between 2 to 10 years old. Outcomes were assessed by measuring tongue mobility, analyzing the articulatory evaluation and reviewing patient questionnaires. RESULTS: The mean length of tongue elevation improved from 7.4 mm preoperatively to 16.3 mm postoperatively (p<0.05). Similarly, the mean length of tongue protrusion improved from 15.0 mm to 26.0 mm (p<0.05). The mean articulation score improved from 8.5 to 9.9 (p<0.05). Parents' subjective satisfaction scores improved from 2.3 to 3.2 (p<0.05). CONCLUSION: Tongue mobility and articulation improved after frenotomy in patients with ankyloglossia.

A Case of Herpes Zoster Laryngitis with Isolated Vagus Nerve Paralysis / 대한이비인후과학회지

Varicella zoster virus may cause a single presence or a combination of various types of cranial nerve palsy depending on the invasion site of head and neck region. Herpes zoster laryngitis has an extremely low incidence particularly in the head and neck region when compared to varicella zoster oticus. Moreover, it has also been reported to occur rarely from a worldwide perspective. The current case is a 63-year old man who visited us with a chief complaint of laryngopharyngeal pain. Flexible fiberoptic laryngoscopy revealed complete right vocal cord palsy fixed at the intermediate position. We experienced a case of Herpes Zoster Laryngitis which was accompanied by a single presence of vagal nerve paralysis. Here, we report our case with a review of literature.

Minimally Invasive Muscle Sparing Transmuscular Microdiscectomy : Technique and Comparison with Conventional Subperiosteal Microdiscectomy during the Early Postoperative Period

OBJECTIVE: The authors introduce a minimally invasive muscle sparing transmuscular microdiscectomy (MSTM) to treat herniated lumbar disc disease. Its results are compared with conventional subperiosteal microdiscectomy (CSM) to validate the effectiveness. METHODS: Muscle sparing transmuscular microdiscectomy, which involves muscle dissection approach using the natural fat cleavage plane between the multifidus to expose the interlaminar space, was performed in 23 patients to treat a single level unilateral lumbar radiculopathy. The creatine phosphokinase (CPK)-MM serum levels were measured on admission and at 1, 3, and 5 days postoperatively. Postoperative pain was evaluated using a 10-point visual analogue scale (VAS) and recorded on admission and at 1, 3, and 5 days postoperatively. The results were compared to those from the conventional subperiosteal microdiscectomy (43 patients). RESULTS: The CPK-MM levels were significantly lower in the serum of the MSTM group compared to the CSM group on postoperative days three and five (p = 0.03 and p = 0.02, respectively). The clinical scales for back pain using VAS were significantly lower in the MSTM group than in the CSM group on postoperative days three (p = 0.04). The mean VAS scores for leg pain in both groups showed no significant differences during the early postoperative period. CONCLUSION: Muscle sparing transmuscular microdiscectomy is a minimally invasive surgical option to treat lumbar radiculopathy due to herniated disc. The approach affected minimal injury to posterior lumbar supporting structures with alleviated postoperative back pain.

Clinical Analysis of Endovenous Laser Treatment Combined with High Ligation for Treatment of Varicose Vein

PURPOSE: Endovenous laser treatment (EVLT) for varicose vein has been shown to be an effective method of treatment. But, after EVLT, recurrence due to recanalization of the great saphenous vein has been identified as a complication. This study was performed to evaluate the effectiveness of EVLT combined with high ligation and to assess the recurrence rate. METHODS: Between April 2004 and April 2009, medical records of 163 patients treated with EVLT combined with high ligation and stab phlebectomy were reviewed retrospectively. Duplex ultrasonography was performed before surgery. All patients were followed up with clinical evaluation at 1 week and 1, 3, and 6 months after operation. The mean follow up period was 5.9 months. RESULTS: In total, 178 limbs of 163 patients were reviewed. In our study, almost all (98.8%) patients had symptomatic and cosmetic improvement. We observed complications such as ecchymosis (22.1%), edema (12.9%), pain (5.5%), and in one case, hematoma. Ecchymosis, edema, and pain were controlled by conservative treatment. The patient with hematoma was hospitalized and improved with conservative therapy. There were no cases of recanalization during the follow up period. CONCLUSION: Compared to previous studies, EVLT combined with high ligation showed satisfactory results, with no recurrence. However, the longer operation time and higher cost were issues and further studies are necessary for objective comparison.

Severe Symptomatic Vasospasm following Intraventricular Hemorrhage from Arteriovenous Fistula

The authors present a rare case of severe vasospasm following the rupture of arteriovenous fistula. On initial CT scan, hematoma in the corpus callosum and left inferior frontal region with surrounding cerebromalacia and all ventricles without apparent subarachnoid hemorrhage were seen. Angiograms showed arterivenous fistula but did not show cerebral vasospasm. Thirteen days after admission the neurological state of patient suddenly deteriorated and bilateral motor weaknesses developed. Following angiograms revealed severe narrowing on the supraclinoid portion of bilateral internal carotid arteries, bilateral anterior cerebral arteries and bilateral middle cerebral arteries. Transluminal angioplasty and intra-arterial papaverine infusion were performed. The patient remained stable with moderate neurologic deficits.

Analysis of Structural Changes of the Inferior Turbinate in Patients with Deviated Nasal Septum by Using Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Compensatory hypertrophy of the inferior turbinate is frequently observed in case of nasal septal deviation. In case of surgical treatment, some advocate that septoplasty must be accompanied by reduction of inferior turbinate. So, the authors analyzed the structural change of the inferior turbinate in nasal septal deviation using the CT scan. SUBJECTS AND METHOD: The CT films of 154 patients who had undergone septoplasty were reviewed retrospectively. All subjects had only Cshaped septal deviation and had no abnormality. Inferior turbinate was divided equally into three portions as anterior, middle and posterior portions. The thickness of mucosa and bone of the inferior turbinate and the degree of inferior conchal bone medialization were measured. RESULTS: In the anterior and middle portion, the degree of medialization at concave side of inferior conchal bone was significantly increased compared to the convex side. In addition, the thickness of bone and mucosa at the concave side was significantly thicker than those of the convex side (p<0.05). However, no significant differences were found in the posterior portion. CONCLUSION: In the nasal septal deviation, the degree of medialization of inferior conchal bone and the thickness of bone and mucosa at the concave side were significantly greater than those of the convex side in the anterior and middle portion.

A Case of Middle Ear Effusion due to Lipoma on the Eustachian Tube / 대한이비인후과학회지

Lipoma of the head and neck region rarely occurs, if any, on the posterior triangle of neck. We have experienced a lipoma on Eustachian tube, which caused recurrent middle ear effusion. A 42-year-old female patient was presented with right aural fullness and hearing disturbance. She had a history of several cases of right middle ear effusion in the past and insertions of ventilation tubes to relieve each of them. A yellowish round mass was found on the pharyngeal orifice of the right Eustachian tube by fiberoptic nasopharyngoscopy. It was removed via endoscopic endonasal approach and there is no evidence of recurrence along about 3 months after the surgery. This would be a good case for the importance of nasopharyngeal examination in patient with middle ear effusion.

Analyses of Cervical Lymph Node Metastases from Papillary Thyroid Cancer

PURPOSE: The management of cervical lymph node metastases from papillary thyroid cancer ranges from selective removal to a radical neck dissection. A clear understanding of the metastases of nodes at potential risk improves the quality of life (QOL) of patients, and through correct surgical methods, based on previous studies; it has been found that lymph node metastasis correlated with a high risk of recurrence. The purpose of our study was to improve the QOL of patients through an appropriate surgical method at the time of the initial operation, which decreases the risk and incidence of reoperation, by reviewing the relationship of multiple variables with cervical lymph node metastases. METHODS: We retrospectively reviewed 123 consecutive patients with papillary thyroid cancer, who underwent a total thyroidectomy with modified radical neck dissection between January 2000 and December 2001. We analysed the relationship between the metastatic pattern, age, sex, tumor location and tumor size, degree of invasion, multicentricity, duration and postoperative complications, in the patients with cervical lymph node metastases. RESULTS: Of the multiple variables, age, sex and capsular invasion were found to significantly correlate with lymph node metastases. CONCLUSION: In patients presenting with capsular invasion, modified radical neck dissections are recommended for palpable cervical lymph nodes, for the prevention of recurrence and reoperation, even when the statistics indicate significance in male patients, or those of a young age, although, further studies with a larger population are required.

A Clinical Comparison of the Mesh Method with the Conventional Herniorrhaphy in Adult Inguinal Hernia

PURPOSE: A tension-free hernioplasty, using mesh prosthetics, has revealed encouraging results in adult inguinal hernia repairs, and is increasingly being performed in Korea. However, there are few reports in Korea analyzing the clinical results of the mesh method. Therefore, this article compares the results of our mesh method with those of the non-mesh method in adult inguinal hernia repairs. METHODS: Between January 2000 and October 2002, 252 herniorrhaphies were performed. With these cases, a retrospective clinical analysis was performed on 52 tension-free herniorrhaphy cases and 48 conventional herniorrhaphy cases. The clinical features analyzed included: age, sex, location, type of operation, operating times, use of postoperative analgesics, length of hospital stays, recurrence rates and complications. RESULTS: The average number of analgesics used was significantly smaller in the mesh than the non-mesh group (P0.05, 4.1 days vs. 4.7 days, respectively). The recurrence rate in the non-mesh method was 6.3% (3/48), but there were no recurrences in the mesh group. Postoperative complications occurred in the non-mesh method group (1 case of a hematoma, and 2 of wound infection), but there were no complications in the mesh group. CONCLUSION: A tension-free herniorrhaphy, with mesh, is a useful technique because it is a pain-relieving operation, with a tendency for lower recurrences and complications than the non-mesh method. Therefore, it is suggest that a tension- free herniorrhaphy, with mesh, may also be a cost effective technique under the Diagnosis Related Group (DRG) system for patients and hospitals.