Introduction to Digital Therapeutics / 대한이비인후과학회지

Digital therapeutics are defined as “deliver evidence-based therapeutic interventions to patients which are driven by high-quality software programs to prevent, manage, or treat medical conditions.” Advances in information and communication technology, artificial intelligence, big data, and digital therapeutics are attracting attention in the healthcare market. Limited access to medical care due to the global epidemic of COVID-19 and the increasing demand for medical care from chronic disease patients owing to the aging of the population have facilitated the expansion of interest in digital health care. As the market size grows, there are currently more than 60 digital therapeutics that have been approved by US Food and Drug Administration, but digital therapeutics are still at an early stage in the market that is not fully established. In this article, we will briefly review the outline of digital therapeutics, the current landscape, future perspectives, and applications of digital therapeutics in the field of otolaryngology.

A Case of Nasal Desmoid Tumor / 대한이비인후과학회지

Desmoid fibromatosis is a very slowly growing benign fibroblast tumor. Locally aggressive and non-metastasizing, it is a well-differentiated, unencapsulated monoclonal myofibroblastic proliferation that has a tendency for local invasion and recurrence. About 15% of all desmoidtype fibromatosis develops within the head and neck. The majority of head and neck desmoid tumor is located in the neck, but less frequently in the face, scalp, oral cavity, mandible, paranasal sinuses, orbit, ear and other structures. We report a very rare case in a 55-year-old female of a desmoid fibromatosis arising from the lateral nasal wall of anterior portion of uncinated process. We discuss the clinicopathologic features and successful treatment of nasal desmoid tumor with a literature review.

Sex-Related Differences of EEG Coherences between Patients with Schizophrenia and Healthy Controls

OBJECTIVES: Alteration of epigenetic effects of testosterone during early development was suggested as an ancillary mechanism for the genesis of schizophrenia. EEG coherence was thought to be a marker for cerebral laterality of which important determinant was testosterone during early development. We studied sex-related differences of EEG coherences between patients with schizophrenia and controls to examine the sex effects in the genesis of schizophrenia. METHODS: EEG was recorded in 35 patients with schizophrenia and 46 healthy controls in the eyes closed resting state. Pair-wise EEG coherences were calculated over delta, theta, alpha, beta and gamma frequency bands. To examine the differences of EEG coherence according to sex in each group, ANCOVA was performed using Statistical Analysis system (SAS, Ver 9.3) and R (Ver 2.15.2). RESULTS: Healthy control males showed more increased right intrahemispheric coherences than healthy control females in delta, theta, alpha and beta frequency bands. In patients with schizophrenia, this male dominant pattern in right intrahemispheric coherences was attenuated especially in alpha and beta bands. Healthy control females showed more increased interhemispheric coherences than healthy control males in delta, theta, beta and gamma frequency bands. In patients with schizophrenia, these female dominant patterns in interhemispheric coherences were attenuated especially in delta, theta, and beta bands, which were commonly observed in frontal to central areas. CONCLUSION: Sex differences in resting EEG coherences were attenuated in schizophrenia patients. These results imply that sex-related aberrant cerebral lateralization might exist in patients with schizophrenia, which are partly due to sex hormones via epigenetic mechanisms.

A Case of Pseudophakic Malignant Glaucoma

PURPOSE: Malignant glaucoma is a rare secondary glaucoma characterized by a flat anterior chamber with increased intraocular pressure (IOP). It may occur after intraocular surgery, trauma, inflammation, the use of miotic agents, and so on. We report a case of malignant glaucoma after uncomplicated phacoemulsification with foldable intraocular lens implantation (IOL) using scleral tunnel incision. METHODS: A 74-year-old woman underwent a phacoemulsification with foldable IOL implantation in her left eye. Ten days after cataract surgery, she had severe ocular pain, a high IOP, and a flat anterior chamber. Pupillary block was suspected, and a peripheral iridectomy was done. But she was referred to our hospital for evaluation of persistent IOP elevation with flat anterior chamber. A diagnosis of pseudophakic malignant glaucoma was made, and we performed a core vitrectomy through peripheral iridectomy site. The anterior chamber deepened postoperatively with control of IOP. On the fourth postoperative day, she developed flattening of the anterior chamber with IOP elevation. A recurrence of malignant glaucoma was diagnosed, and anterior vitrecomy with a widening of previous iridectomy wound was done. RESULTS: Postoperatively, the patient had normal IOP, a deep anterior chamber and improved visual acuity. We got successful results from a surgical anterior vitrecomy through peripheral iridectomy site.

The Effect of Apraclonidine Hydrochloride 0.5%Ve rsus 1%for Controlling Intraocular Pressure Elevation after Nd :YAG Laser Posterior Capsulotomy

Previous reports have shown that Nd:YAG laser capsulotomy is associated with elevated intraocular pressure(IOP). Topical apraclonidine hydrochloride has been shown to be effective in preventing postlaser pressure spikes. This study was designed to compare the effect of apraclonidine hydrochloride 0.5%versus 1% in controlling IOP elevation after Nd:YAG laser posterior capsulotomy. Fourteen eyes were treated with 0.5%apraclonidine(Group 1), twenty eyes with 1%apraclonidine(Group 2)and fifteen eyes without apra-clonidine(Group 3)in Nd:YAG laser posterior capsulotomy. The mean post-operative IOP at 1 to 3 hours of Group 3(15.0+/-3.6 mmHg, 16.0+/-4.3 mmHg) was higher than Group 1(10.8+/-3.5 mmHg, 11.6+/-3.0 mmHg)and Group 2 (11.2+/-3.0 mmHg, 12.7+/-2.3 mmHg)(P0.05). This result suggests that 0.5%and 1%apraclonidine are equally effective in preventing IOP rise and 0.5%apraclonidine can be a useful adjunct in preventing IOP elevation following Nd:YAG laser posterior capsulotomy.

An Effects of Contact Transscleral Diode Laser Cyclophotocoagulation in Refractory Glaucoma Patients

We evaluated the the effect and the suitable level of ciliary ablation with diode laser contact transscleral cyclophotocoagulation[TSCPC] in eyes with refractory glaucoma. Fourteen eyes were treated with contact transscleral cyclophotocoagulation on 180 degree[Group 1, 6 eyes], and 270 degree[Group 2, 8 eyes], and the intraocular pressure was measured at 1 day, 1 week, 1 month, 3 month, postoperatively. The mean preoperative intraocular pressure was 46.8+/-14.3 mmHg and the mean intraocular pressure at last examination was 29.5+/-13.2 mmHg. Success rate was defined as follows:[1] more than 20% intraocular pressure reduction from baseline, [2] less than 21 mmHg at final examination. Based on the definition of success 1, the success rate was 66.6% in group 1 and 87.5% in group 2. Based on the definition of success 2, the success rate was 50% in both group. It suggests that contact transscleral cyclophotocoagulation with diode laser is useful in lowering IOP in refractory glaucoma patients and the treatment is also effective with ablation of 180 degree area in refractory glaucoma patients.

A Case of Dural Arterio-venous Malformation Involving the Cavernous Sinus

Dural arterio-venous malformations are vascular communications in which blood flows through small meningeal branches of the carotid arteries to enter the venous circulation near the cavernous sinus. Dural arterio-venous malformations are distinct neuroophthalmological syndrome which consisisted of symptoms such as exphthalmos, increased intraocular pressure, ipsilateral headache, and dilatation of episcleral vessels, but they are difficult to diagnose clinically. Moreover it is difficult to differentiate them from the more common carotid-cavernous fistulas which represent similar symptoms of dural arteio-venous malformations. We report a case of dural arteriovenous malformation, involving the cavernous sinus and confimed with selective carotid arteriography, in a patient who presented with symptoms of unilateral tinnitus, conjunctival injection, and raised intraocular pressure, along with the review of literatures.

Transient Visual Loss after Retrobulbar Anesthesia in the Advanced Glaucoma Patients

Retrobulbar Anesthesia is injecting local anesthetics into the retrobulbar space within the muscle cone, which affects the third cranial nerve, ciliary ganglion and optic nerve. Proper retrobulbar anesthesia can temporarily weaken somatosensory, motor and visual sensory. It also narrows visual fields. However, it does not result in complete loss of visual acuity. According to the authors, all 4 advanced cases which showed transient and complete visual loss after retrobulbar anesthesia of Lidocaine Hcl[2% lidocaine, einephrine, 1:100,000] were advanced glaucoma patients who had normal fundus except glaucomatous change and self-recovered within 1 to 4 hours. The decrease in vision may be related to the effects of the anesthetic agent on the optic nerve, or it may be related to the relative ischemia produced by compression, or caused by entopsias induced by compression. The authors cases suggest that transient visual loss after retrobulbar anesthesia may not reduce postoperative visual acuity and visual fields in the advanced glucoma patients.

Optic Nerve Evulsion: 1 case report

Optic nerve evulsion is a visually devastating and rare manifestation resulting in sudden visual loss after ocular trauma. The several hypothesis of mechanism include penetrating orbital injury causing a backward pull on the optic nerve, extreme rotation and forward displacement of the globe, and sudden increase in intraocular pressure causing rupture of the lamina cribrosa. The authors report a case of optic nerve evulsion in a 25- year old man who was struck in the right eye with a umbrella. The diagnosis was made by fundoscopic findings, fluorescein angiography, visual evoked potential, electroretinography, orbit computed tomography and magnetic resonance image.

A Comparison of Cyclocryotherapy and Contact Transscleeral Cyclophotocoagulation with Diode Laser in Rabbit

Cyclodestruction is generally achieved by applying thermal energy across the intact sclera. Commonly employed modalities are ultrasound, cryopexy, diathermy, noncontact laser light and most recently, contact transscleral laser using argon, krypton and Nd:YAG, diode laser. This study was performed to compare the pressure lowering and tissue effects of contact transscleral cyclophotocoagulation(TSCPC) with diode laser using G prode to cyclocryotherapy in rabbit. The results of this study demonstrate a similar intraocular pressure lowering effect of both cyclocryotherapy and contact TSCPC with diode laser using G prode. Histologic studies showed that both TSCPC and cyclocryotherapy are effective anatomic cyclodetructive modalities but in case of TSCPC, less severe destruction of ciliary body was noted. This study indicated that contact TSCPC with diode laser using G probe delivery provieds effective and safe management for eyes with medically and surgically uncontrolled glaucoma compared to cyclocryotheraphy.

Ultrastructural Changes of Lead Acetate Induced Liver Injury in Rats

To evaluate the ultrastructural changes and the mechanism causing liver injury by lead, light and electron microscopic(LM and EM) examination using Timm sulphide silver method(TSM) was done. Sprague-Dawley rats were divided into a control and 3 experimental groups. The experimental groups were orally administered 0.5% lead acetate(LA). Group 1 received a one time dose of 10 ml of LA by gastric intubation. Groups 2 and 3 continuously received LA instead of drinking water. The control group was composed of 3 rats in each group which did not receive any treatment. Rats of group 1, 2 and 3 and control were sacrificed at 1/2, 1, 1 1/2 hours, 2 days, and at 1, 2, 4, 6 and 8 weeks later, except group 3. Before sacrifice, they were perfused with 0.1% sodium sulphide and 2.5% glutaraldehyde through the abdominal aorta for TSM. The liver was taken for LM and EM examinations. Blood lead concentration began to increase from the 2nd day up to 3.29 microgram/ml at 2nd week, and the urinary delta-ALA level showed a steady increase from the 2nd day. LM and EM examination of liver revealed that absorbed lead granules in group 1 were transported into sinusoidal spaces, Kupffer cells, and the hepatocytes within 1 hour and then disappeared 1/2 hour thereafter. In group 2 deposited lead was found in the hepatocytic cytosol bound to mitochondria. That in turn inhibited mitochondrial respiration with resultant mitochondrial swelling at the 1st week and thereafter at 6th week myelin figure formation and condensation of mitochondria, and peroxisomes were increased at 8th week. Based on these results it can be concluded that a transient intake of subletal dose of LA is biotransformed completely by periportal hepatocytes within 1 1/2 hours, but excessively accumulated lead can induce liver cell injury due to lipid peroxidation of membrane by direct toxic effect of lead and by products of lipid peroxidation. We postulate that lead acetate triggers presumably primarily mitochondrial membrane injury and then other organellar changes may play a role in disturbance of a network of interacting of key events capable of causing cell death.