Updated Trans-Ethnic Meta-Analysis of Associations between Inflammation-Related Genes and Intracranial Aneurysm

Objective@#: We performed an expanded multi-ethnic meta-analysis to identify associations between inflammation-related loci with intracranial aneurysm (IA) susceptibility. This meta-analysis possesses increased statistical power as it is based on the most data ever evaluated. @*Methods@#: We searched and reviewed relevant literature through electronic search engines up to August 2022. Overall estimates were calculated under the fixed- or random-effect models using pooled odds ratio (OR) and 95% confidence intervals (CIs). Subgroup analyses were performed according to ethnicity. @*Results@#: Our meta-analysis enrolled 15 studies and involved 3070 patients and 5528 controls including European, Asian, Hispanic, and mixed ethnic populations. Of 17 inflammation-related variants, the rs1800796 locus (interleukin [IL]-6) showed the most significant genome-wide association with IA in East-Asian populations, including 1276 IA patients and 1322 controls (OR, 0.65; 95% CI, 0.56–0.75; p=3.24×10-9) under a fixed-effect model. However, this association was not observed in the European population (OR, 1.09; 95% CI, 0.80–1.47; p=0.5929). Three other variants, rs16944 (IL-1β), rs2195940 (IL-12B), and rs1800629 (tumor necrosis factor-α) showed a statistically nominal association with IA in both the overall, as well as East-Asian populations (0.01

Decreased Hippocampal Metabolism in Amnestic Mild Cognitive Impairment: Positron Emission Tomography Study

Objective@#Little is known about factors influencing of hippocampal metabolism (HM) in mild cognitive impairment (MCI). Our objective was to determine whether HM in patients with amnestic MCI (aMCI) is decreased than non-amnestic MCI (naMCI). @*Methods@#Overall, 32 MCI patients underwent 18F-fluorodeoxyglucose-positron emission tomography. They were characterized as aMCI (n=18) or naMCI (n=14) according to comprehensive neuropsychological criteria. Analysis of variances were used to assess differences on HM between aMCI and naMCI after controlling age, sex, education and Korean version of Mini Mental Status Examination. @*Results@#We found that HM was more decreased in aMCI than naMCI. This result was not changed after controlling hippocampal volume. @*Conclusion@#Our findings suggest that aMCI is associated with decreased HM in MCI.

Protective effect of Cordyceps militaris against hydrogen peroxide-induced oxidative stress in vitro

BACKGROUND/OBJECTIVES: Excessive production of reactive oxygen species (ROS) such as hydroxyl (·OH), nitric oxide (NO), and hydrogen peroxide (H2O2) is reported to induce oxidative stress. ROS generated by oxidative stress can potentially damage glial cells in the nervous system. Cordyceps militaris (CM), a kind of natural herb widely found in East Asia. In this study, we investigated the free radical scavenging activity of the CM extract and its neuroprotective effects in H2O2-induced C6 glial cells. MATERIALS/METHODS: The ethanol extract of CM (100–1,000 µg/mL) was used to measure DPPH, ·OH, and NO radical scavenging activities. In addition, hydrogen peroxide (H2O2)-induced C6 glial cells were treated with CM at 0.5–2.5 µg/mL for measurement of cell viability, ROS production, and protein expression resulting from oxidative stress. RESULTS: The CM extract showed high scavenging activities against DPPH, ·OH, and NO radicals at concentration of 1,000 µg/mL. Treatment of CM with H2O2-induced oxidative stress in C6 glial cells significantly increased cell viability, and decreased ROS production. Cyclooxygenase-2 and inducible nitric oxide synthase protein expression was down-regulated in CM-treated groups. In addition, the protein expression level of phospho-p38 mitogen-activated protein kinase (p-p38 MAPK), phospho-c-Jun N-terminal kinase (p-JNK), and phospho-extracellular regulated protein kinases (p-ERK) in H2O2-induced C6 glial cells was down-regulated upon CM administration. CONCLUSION: CM exhibited radical scavenging activity and protective effect against H2O2 as indicated by the increased cell viability, decreased ROS production, down-regulation of inflammation-related proteins as well as p-p38, p-JNK, and p-ERK protein levels. Therefore, we suggest that CM could play the protective role from oxidative stress in glial cells.

A 4-Axis Technique for Three-Dimensional Printing of an Artificial Trachea

BACKGROUND: Several types of three-dimensional (3D)-printed tracheal scaffolds have been reported. Nonetheless, most of these studies concentrated only on application of the final product to an in vivo animal study and could not show the effects of various 3D printing methods, materials, or parameters for creation of an optimal 3D-printed tracheal scaffold. The purpose of this study was to characterize polycaprolactone (PCL) tracheal scaffolds 3D-printed by the 4-axis fused deposition modeling (FDM) method and determine the differences in the scaffold depending on the additive manufacturing method. METHODS: The standard 3D trachea model for FDM was applied to a 4-axis FDM scaffold and conventional FDM scaffold. The scaffold morphology, mechanical properties, porosity, and cytotoxicity were evaluated. Scaffolds were implanted into a 7 × 10-mm artificial tracheal defect in rabbits. Four and 8 weeks after the operation, the reconstructed sites were evaluated by bronchoscopic, radiological, and histological analyses. RESULTS: The 4-axis FDM provided greater dimensional accuracy and was significantly closer to CAD software-based designs with a predefined pore size and pore interconnectivity as compared to the conventional scaffold. The 4-axis tracheal scaffold showed superior mechanical properties. CONCLUSION: We suggest that the 4-axis FDM process is more suitable for the development of an accurate and mechanically superior trachea scaffold.

Comparison of the effect of three licorice varieties on cognitive improvement via an amelioration of neuroinflammation in lipopolysaccharide-induced mice

BACKGROUND/OBJECTIVES: Neuroinflammation plays critical role in neurodegenerative disorders, such as Alzheimer's disease (AD). We investigated the effect of three licorice varieties, Glycyrhiza uralensis, G. glabra, and Shinwongam (SW) on a mouse model of inflammation-induced memory and cognitive deficit. MATERIALS/METHODS: C57BL/6 mice were injected with lipopolysaccharide (LPS; 2.5 mg/kg, intraperitoneally) and orally administrated G. uralensis, G. glabra, and SW extract (150 mg/kg/day). SW, a new species of licorice in Korea, was combined with G. uralensis and G. glabra. Behavioral tests, including the T-maze, novel object recognition and Morris water maze, were carried out to assess learning and memory. In addition, the expressions of inflammation-related proteins in brain tissue were measured by western blotting. RESULTS: There was a significant decrease in spatial and objective recognition memory in LPS-induced cognitive impairment group, as measured by the T-maze and novel object recognition test; however, the administration of licorice ameliorated these deficits. In addition, licorice-treated groups exhibited improved learning and memory ability in the Morris water maze. Furthermore, LPS-injected mice had up-regulated pro-inflammatory proteins, such as inducible nitric oxide synthase (iNOS), cyclooxygenase-2, interleukin-6, via activation of toll like receptor 4 (TLR4) and nuclear factor-kappa B (NFκB) pathways in the brain. However, these were attenuated by following administration of the three licorice varieties. Interestingly, the SW-administered group showed greater inhibition of iNOS and TLR4 when compared with the other licorice varieties. Furthermore, there was a significant increase in the expression of brain-derived neurotrophic factor (BDNF) in the brain of LPS-induced cognitively impaired mice that were administered licorice, with the greatest effect following SW treatment. CONCLUSIONS: The three licorice varieties ameliorated the inflammation-induced cognitive dysfunction by down-regulating inflammatory proteins and up-regulating BDNF. These results suggest that licorice, in particular SW, could be potential therapeutic agents against cognitive impairment.

Effect of Drug-Induced Sedation Endoscopy on the Decision of Treatment Plan in Patients with Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Drug-induced sedation endoscopy (DISE) has recently gained popularity among otolaryngologists because it can provide direct information of upper airway obstruction in patients with obstructive sleep apnea (OSA). In that regard, we examined how DISE examination affected the decision of clinician's treatment plan and the consequent patient's compliance in OSA patients. SUBJECTS AND METHOD: All enrolled patients were classified into two groups according to the method of upper airway evaluation employed: a physical examination only group and a physical examination combined with DISE group. The clinician's treatment plan was categorized into the following four groups: sleep surgery, positive airway pressure, oral appliance, and sleep surgery combined with oral appliance. The change of patient's compliance was also evaluated. RESULTS: There were several differences in how DISE evaluation affected the decision of clinician's treatment plan and patient's compliance between the two groups. The rate for sleep surgery fell from 69.6% to 15.9%; on the other hand, the rate for positive airway pressure, oral appliance and sleep surgery combined with oral appliance all increased from 13.0% to 36.2%, 14.5% to 26.6%, and 2.9% to 21.3%, respectively. The patient's compliance also changed after DISE evaluation: sleep surgery, positive airway pressure, oral appliance and sleep surgery combined with oral appliance all increased from 78.1% to 87.9%, 16.7% to 76.0%, 25.0% to 87.3%, and 50.0% to 91.03%, respectively. CONCLUSION: We found that DISE examination influences the decision of clinician's treatment plan and patient's compliance. We suggest additional cohort studies to confirm these findings.

Analysis of Long-Term Complication on Patients with Obstructive Sleep Apnea Who Treated Mandibular Advancement Device / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, mandibular advancement device (MAD) has been used widely used for the treatment of obstructive sleep apnea (OSA) because it can effectively reduce the collapsibility of upper airway during sleep. Although MAD is widely prescribed by otorhinolaryngologists, several studies described its complications arising from the anterior placement of the mandible with long-term use. However, there is still a lack of studies on long-term complications in Korean patients. SUBJECTS AND METHOD: Retrospectively, we included a total of 57 OSA patients in the study. In this study, all enrolled OSA patients had used MAD over two years with more than 4 hours/day. Dental consulting and cephalometric analysis were conducted to identify the change of dental and skeletal findings at two different times (baseline and after 2 year). RESULTS: The dental findings showed that the overbite and overjet were significantly decreased. Additionally, the proclination of the lower incisors were increased significantly, whereas there was no significant change on the retroclination of the upper incisors. Three patients showed a change of malocclusion type. On the analysis of skeletal findings, we found a significant increase in the sella turcica central point-nasion-supramental point angle and a decrease in the subspinal point-nasion-supramental point angle. Moreover, the anterior lower facial height and anterior facial height were significant increased. CONCLUSION: Consistent with Western studies, our findings suggest that the long-term use of MAD could induce changes in dental and skeletal morphologies in Korean OSA patients. Therefore, clinicians should thoroughly evaluate potential changes in dental and skeletal morphologies when they prescribe MAD to patients with OSA.

Kimchi attenuates fatty streak formation in the aorta of low-density lipoprotein receptor knockout mice via inhibition of endoplasmic reticulum stress and apoptosis

BACKGROUND/OBJECTIVES: Endoplasmic reticulum (ER) stress is positively associated with atherosclerosis via elevating macrophage cell death and plaque formation, in which oxidative stress plays a pivotal role. Antioxidative, lipid-lowering, and anti-atherogenic effects of kimchi, a Korean fermented vegetable, have been established, wherein capsaicin, ascorbic acid, quercetin, 3-(4'-hydroxyl-3',5'-dimethoxyphenyl)propionic acid, and lactic acids were identified. In this study, mechanisms of action of kimchi methanol extracts (KME) on fatty streak formation via suppression of ER stress and apoptosis in aorta were examined in low-density lipoprotein receptor knockout mice. MATERIALS AND METHODS: Mice fed a high cholesterol diet with an oral administration of KME (KME group, 200 mg·kg-bw⁻¹·day⁻¹) or distilled water (control group) for 8 weeks (n = 20 for group). Plasma lipid and oxidative stress levels were evaluated. Protein expression was measured by western blot assay. Fatty streak lesion size and the degree of apoptosis were examined in the aorta. RESULTS: Compared to the control group, in the KME group, plasma lipids levels were decreased and oxidative stress was alleviated (P < 0.05). Protein expression levels of nuclear factor (erythroid-derived 2)-like 2-mediated antioxidants in aorta were increased whereas those for ER stress markers, glucose regulated protein 78, phospho-protein kinase RNA-like ER kinase, phospho-eukaryotic initiation factor 2 subunit α, X-box binding protein 1, and C/EBP homologous protein were decreased in the KME group (P < 0.05). Moreover, apoptosis was suppressed via downregulation of phospho-c-Jun N-terminal kinase, bcl-2-associated X protein, caspases-9, and -3 with a concomitant upregulation of anti-apoptotic protein, B-cell lymphoma 2 (P < 0.05). Fatty streak lesion size was reduced and the degree of apoptosis was less severe in the KME group (P < 0.05). CONCLUSIONS: In conclusion, antioxidant activity of KME might prevent fatty streak formation through, in part, inhibition of ER stress and apoptosis in aortic sinus where macrophages are harbored.

Application of a Collagen Patch Derived from Duck Feet in Acute Tympanic Membrane Perforation

We investigated the utility of the duck-feet collagen extraction patching procedure in the traumatic tympanic membrane (TM) perforation via a comparison with spontaneous healing or paper patch. Fifty-six ears of adult male Sprague-Dawley rats, each weighing in the range of 250 to 300 g, were used for the animal studies. Sixteen rats had one-side ear in the control group and the opposite-side ear in the treated groups. The remaining twelve rats had a one-side ear with the duck-feet collagen patch and the opposite-side ear with a paper patch. The proliferating cell nuclear antigen (PCNA) expression cells were calculated among the 200 basal cells, and the expression percentage was identified as the labeling index. The healing of the perforation in the duck-feet collagen patch group was confirmed to be more rapid compared to the healing of the other groups. PCNA staining was observed in the migrating portion of PCNA enhanced cell to collagen scaffold in Post operative day (POD) 7 of collagen patch group. Thus, the adhesive effect of the duck-feet collagen patch to perforated margin was better than that of the paper patch. After completing the healing process, the collagen patch shrank and detached from the tympanic membrane (POD 14). In this study, we confirmed that the use of a duck-feet collagen patch had the advantage of early healing, inducing natural TM contour, and disappearing ability after the patch effect is complete.

Fabrication and Characterization of Hydrocolloid Dressing with Silk Fibroin Nanoparticles for Wound Healing

Hydrocolloid dressings have been developed for many types of wound healing. In particular, dressing is a critical component in the successful recover of burn injuries, which causes a great number of people to not only suffer from physical but also psychological and economic anguish each year. Additionally, silk fibroin is the safest material for tissue engineering due to biocompatibility. In this study, we fabricated hydrocolloid dressings incorporating silk fibroin nanoparticles to enhance the efficacy of hydrocolloid dressing and then use this silk fibroin nanoparticle hydrocolloid dressing (SFNHD) in animal models to treat burn wounds. The structures and properties of SFNHD were characterized using tensile strength and Cell Counting Kit-8 assay. The results indicated the structural stability and the cellular biocompatibility of the hydrocolloid dressing suggesting that SFNHD can be applied to the treatment of wounds. To demonstrate the capacity of a silk fibroin hydrocolloid dressing to treat burn wounds, we compared SFNHD to gauze and Neoderm®, a commercially available dressing. This study clearly demonstrated accelerated wound healing with greater wound structural integrity and minimal wound size after treatment with SFNHD. These observations indicate that SFNHD may be an improvement upon current standard dressings such as Gauze and Neoderm® for burn wounds.

In Reply: Treatment for Acute Tympanic Membrane Perforation

No abstract available.

Application of Three-Dimensional Printing in Facial Plastic and Reconstructive Surgery / 대한이비인후과학회지

Recently, three-dimensional (3D) printing technology can produce any 3D shape of solid scaffolding that can be designed by digital image. Thus, there are many potential patient-specific applications for 3D printing in medicine, including facial plastic and reconstructive surgery, which could have a significant impact in changing the ways patients are treated for various conditions in the future. To date, individually printed metal implants and synthetic devices are currently being used on limited cases in various medical fields, including facial plastic and reconstructive surgery. Herein we describe concepts and characteristics of 3D printing technology and its clinical applications in facial plastic and reconstructive surgery.

Clinical Outcomes of Silk Patch in Acute Tympanic Membrane Perforation

OBJECTIVES: The silk patch is a thin transparent patch that is produced from silk fibroin. In this study, we investigated the treatment effects of the silk patch in patients with traumatic tympanic membrane perforation (TTMP). METHODS: The closure rate, otorrhea rate, and closure time in all patients and the closure time in successful patients were compared between the paper patch and silk patch groups. RESULTS: Demographic data (gender, site, age, traumatic duration, preoperative air-bone gap, and perforation size and location) were not significantly different between the two groups. The closure rate and otorrhea rate were not significantly different between the two groups. However, the closure time was different between the two groups (closure time of all patients, P=0.031; closure time of successful patients, P=0.037). CONCLUSION: The silk patch which has transparent, elastic, adhesive, and hyper-keratinizing properties results in a more efficient closure time than the paper patch in the treatment of TTMP patients. We therefore believe that the silk patch should be recommended for the treatment of acute tympanic membrane perforation.

Predictors of Adherence with Positive Airway Pressure Treatment in Patients with Obstructive Sleep Apnea in Korean

BACKGROUND AND OBJECTIVES: Application of automatic positive airway pressure (APAP) is regarded as the primary therapy for patients with obstructive sleep apnea syndrome (OSAS). However, a low adherence rate is a major problem with APAP treatment in OSAS patients. Therefore, the aim of the present study is to assess factors related to good adherence of APAP therapy in OSAS Korean patients. MATERIALS AND METHOD: Of 112 consecutive newly diagnosed moderate to severe OSAS patients, 70 were enrolled in this study. All patients received APAP therapy for 2 weeks, along with reinforcing intervention, consisting of motivational reinforcement and technical support. All APAP therapy involved a device rental service. After 2 weeks of treatment, patients had to choose the kind of treatment for OSAS [APAP therapy (good adherence) or alternative treatment options (poor adherence)]. RESULTS: After 6 months, the adherence rate to APAP therapy was 35.7% (n=25). No statistically significant difference was observed between the good and poor adherence groups with regard to snoring intensity, apnea-hypopnea index, and mean O2 saturation after adjusting for age, sex, body mass index, marital status, and socioeconomic status. However, we found that excessive daytime sleepiness and lowest O2 saturation were significantly associated with good adherence [adjusted odds ratios (ORs)=9.515 and 2.327] after adjusting for age, sex, body mass index, marital status, and socioeconomic status. CONCLUSION: Our findings suggest that excessive daytime sleepiness and lowest O2 saturation are important factors to identify good adherence to APAP treatment in Korean OSAS patients.

Drug Induced Sleep Endoscopy for Poor-Responder to Uvulopalatopharyngoplasty in Patient with Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate drug-induced sleep endoscopy (DISE) findings in patients with persistent obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP) surgery. SUBJECTS AND METHOD: Patients were included in this study if they had a postoperative DISE evaluation as well as pre- and postoperative polysomnography. DISE findings included the obstructive sites (velum, oropharyngeal lateral walls, tongue base, and epiglottis), and the obstructive patterns of velopharynx (anteroposterior, lateral, and concentric). RESULTS: A total of 77 patients were included in this study. Poor-responder patients to UPPP (n=50) and well-responder patients to UPPP (n=27) were similar with regard to age, gender, body mass index, preoperative AHI, and minimal O2 saturation. In our analysis of DISE findings on poor-responder, velopharynx was the most common obstruction site (100%), followed by oropharynx (88%), tongue base (70%), and epiglottis (44%). Results showed that most patients (n=49) had multiple obstructive sites. No significant differences according to position dependency and REM dependency were found in obstructive sites. However, severe OSA patients had tongue base obstruction more frequently than the moderate OSA patients did. The obstructive pattern of velopharynx usually showed concentric configuration (70%, 35 of 50). CONCLUSION: Our results suggest that the preoperative DISE may be a useful method for determination of the personalized surgery to OSA patients because of its more precise information to upper airway obstruction.

The Successful Reduction of an Anterior Maxillary Fracture with Foley Catheter and Real-Time Ultrasonography / 대한이비인후과학회지

Maxillary fractures are common traumas in facial lesions, frequently involving the thin bony anterior wall. Minimally invasive operations have been tried in these maxillofacial areas; for example, the Foley balloon inflation technique guided by nasal endoscopy in orbital blow-out fractures have been recently reported with a high success rate. However, in maxillary anterior wall fractures, these minimally invasive surgical procedures have seldom been reported. This report presents the case of a 24-year-old man with an anterior maxillary wall fracture. The fracture was treated with a minimally invasive method that uses an endoscopic approach to the maxillary antrum with a Foley catheter ballooning, which was monitored by real-time ultrasonography. This report presents the imaging studies and a description of the endoscopic procedure.

The Trend of Biomaterials in Facial Plastic and Reconstructive Surgery / 대한이비인후과학회지

Recently, tissue engineering has been proposed as an alternative to reconstruct or replace craniofacial defect in facial plastic and reconstructive surgery. The biomaterials are the most important component of tissue engineering. Generally, the biomaterials are defined as any material that is used to replace or restore function to a body tissue and is continuously or intermittently in contact with body fluid. Thus, biostability, biocompatibility, and interfacial-compatibility are required in biomaterials to use for tissue engineering. Herein, we describe characteristics and category of biomaterials, and its clinical applications in facial plastic and reconstructive surgery.

Congenital Cholesteatoma Localized to the Tip of the Mastoid Bone: A Case Report and Possible Etiology

Congenital cholesteatomas of mastoid origin are extremely rare. We reported one in 2007 and experienced an additional case. A male presented with a 5-month history of right-sided ear discharge. Computed tomography of the temporal bone showed a soft tissue density occupying the mastoid tip. At surgery, the cholesteatoma sac was completely isolated from the mastoid antrum and lateral air cell in the mastoid tip area. We now doubt the rarity of this entity. With a brief literature review, we consider how the cholesteatoma localizes to the tip of the mastoid bone.

A Case of Paraffinoma Removal Using Endoscope-Assisted Microdebrider

Paraffin has been used illegally in Korea for many years as an oil-soluble substance to augment depressed nasal dorsum. Here we describe the successful management of a case of nasal paraffinoma using an endoscope-assisted microdebrider and primary reconstruction using autologous dermofat and Gore Tex. The patient was placed in the supine position under general anesthesia, and bilateral intercartilaginous incisions were made. The endoscopic views provided an extended image that aided in identifying paraffinoma within the soft tissue. The paraffinoma was removed with a microdebrider. The dorsal defect and irregularities were reconstructed using dermofat and Gore-Tex.At the four-year follow-up, the patient was satisfied with the cosmetic results, and there was no evidence of recurrence.

Transverse Fracture of the Stapes Anterior Crus Caused by the Blast Pressure from a Land Mine Explosion

Stapes fractures without other ossicle problems are rare and ossicle problems due to explosion pressure are also rare. We describe a very rare case of stapes anterior crural fracture resulting from a land mine explosion. As this case suggests, a close examination of the ossicles is necessary during an exploration tympanotomy.