The Impact of Vascular Access for In-Hospital Major Bleeding in Patients with Acute Coronary Syndrome at Moderate- to Very High-Bleeding Risk

The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate- to very high-bleeding risk.

The Effect of Septoturbinoplasty for Quality of Life in Patients with Sleep-Disordered Breathing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal obstruction is common in patients with sleep disordered breathing (SDB). Polysomnography (PSG) is a standard diagnositc tool for sleep disorders, but it can not evaluate the quality of life (QOL). We tried to assess the efficacy of the septoturbinoplasty on patients with SDB and nasal obstruction by using self reported measures that have been known as a tool for evaluating the general and disease specific QOL. SUBJECTS AND METHOD: Thirty-five patients who had snoring and sleep apnea confirmed by PSG and symptomatic nasal obstruction caused by deviated nasal septum were enrolled. All patients underwent septoturbinoplasty to improve nasal obstruction. QOL was assessed before and 2 months after surgery. Medical Outcome Study Short Form 36 (SF-36) and Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Stanford Sleepiness Scale (SSS), Insomnia Severity Index (ISI), Beck Depression Inventory (K-BDI), Nasal Obstruction Symptom Evaluation (NOSE) scale were included in the measures. A statistical analysis was performed using a paired t-test. RESULTS: Snoring sound level, PSQI, ESS, ISI, and NOSE were improved significantly (p0.05). CONCLUSION: QOL in patients with SDB and nasal obstruction was improved by nasal surgery. Different kinds of self-reported measures could be more informative as they can provide pre and post treatment results with respect to psychosomatic effects in patients with SDB.

Comparison of Electron Beam Tomography and Multi Detector Computed Tomography for Dynamic Upper Airway Study in Snorers

Although there are many kinds of modalities to evaluate upper airway obstruction region in snorers and obstructive sleep apnea subjects, we still have many difficulties to evaluate dynamic upper airway mechanics exactly. We investigated whether multi detector CT (MD-CT) is a good tool comparable with electron beam tomography (EBT) for evaluating upper airway dynamics. Each twenty snorers using EBT and MD-CT were included in this study. We evaluated dynamic upper airway mechanics at supine position in awake and asleep state by serial scan image. The space from hard palate to epiglottis tip were divided into four parts; high retropalate (HRP), lower retropalate (LRP), high retroglossal (HRG), lower retroglossal (LRG). We measured minimal cross sectional area (mCSA), maximal cross sectional area (MCSA), and collapsibility index (CI) in each area. Using cross sectional area data also made the simulated diagram of longitudinal view. Maximal stenotic regions of longitudial view were at LRP and HRG area in 18 patients of EBT and 17 patients of MD-CT. mCSA and volume were decreased significantly at asleep state than awake state and CI was increased in both EBT and MD-CT cases. mCSA was smallest at the LRG area and CI was largest at the HRG area and these results were prominent at the asleep state than the awake state. EBT and MD-CT are efficient modalities for dynamic upper airway mechanics due to short scan time. From economical point of view and resolution power, MD-CT is regarded as more efficient modality for evaluating dynamic upper airway mechanics.

Alteration in Expression of p27(Kip1) in Mouse Vestibular Epithelia during Apoptosis Induced by Gentamicin / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: p27(Kip1), a novel cyclin-dependent kinase inhibitor, plays a crucial role in regulation of cell proliferation during development of inner ear. In addition, p27(Kip1) is known to regulate cell death in avian auditory epithelia. However, only a little is known about its role in aminoglycoside-induced mammalian vestibular degeneration. The aim of this study was to examine roles of p27(Kip1) in gentamicin-induced vestibulotoxicity. MATERIALS AND METHOD: C57BL/6J mice were used as experimental animals. Ampullar cristae damaged by local application of gentamicin were provided for histological analyses and western blotting. TUNEL assay was used to detect apoptosis. Immunohistochemistry and western blotting for p27(Kip1) were performed to investigate its expression. RESULTS: TUNEL-positive cells were detected in the hair cells of gentamicin-treated mice. Expression of p27(Kip1) was found in the supporting cells, but not in the hair cells. Gentamicin treatment caused degeneration of vestibular hair cells, and a decrease of numbers of p27(Kip1)-positive cells. The western blotting showed that expression of p27(Kip1) was markedly decreased on day 3. CONCLUSION: The present findings indicate that p27(Kip1) may play roles in repair of hair cells by regenerative proliferation or transdifferentiation of supporting cells, but not in cell death of hair cells.

The Effects of Saline Solution Irrigation on Nasal Mucus Secretion: in vivo and in vitro Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various saline solution formulae have been used frequently in patients with rhinosinusitis. However, there are not enough scientific evidences supporting the effect of irrigation of the nose with saline solution. We investigated the effects of saline solution on mucus secretion, vascular response, subjective symptoms and nasal cavity air-space volume changes using in vitro and in vivo test. MATERIALS AND METHOD: In vitro study, inferior turbinate mucosa were harvested from patients who had chronic hypertrophic rhinitis. These were incubated with 0.9%, 3%, 6% of saline solutions, and control solution. Concentrations of mucin and lysozyme were measured from them. In vivo study, the nasal cavity of normal control group and patients with septal deviation were irrigated with 0.9%, 3%, 6% of saline solutions. Lavage fluids were collected from the ipsilateral and contralateral sides to measure the concentrations of varies constituents such as mucin, lysozyme, total protein, and albumin. Patients recorded subjective symptoms and nasal cavity air-space volume was assessed by acoustic rhinometry after each irrigations. RESULTS: In vitro study, the concentrations of mucin and lysozyme were increased in the dose-dependent manner by increasing the osmolarity. In vivo study, the sensation of rhinorrhea, pain and nasal blockage were increased as the concentration of saline increased. Furthermore, the concentrations of mucus and total protein also increased by increasing concentration of saline solution at ipsilateral side. However, contralateral reflex-mediated effect were negligible. There was no change in air-space volume. CONCLUSION: The saline solution induced secretion of mucus mignt be through axon reflex mediated neuronal effect. The increased mucus may change the rheology of mucus which, in turn, could increase mucociliary action in the nasal cavity.