Association of Metabolic Syndrome with Sensorineural Hearing Loss.

The prevalence of sensorineural hearing loss has increased along with increases in life expectancy and exposure to noisy environments. Metabolic syndrome (MetS) is a cluster of co-occurring conditions that increase the risk of heart disease, stroke and type 2 diabetes, along with other conditions that affect the blood vessels. Components of MetS include insulin resistance, body weight, lipid concentration, blood pressure, and blood glucose concentration, as well as other features of insulin resistance such as microalbuminuria. MetS has become a major public health problem affecting 20-30% of the global population. This study utilized health examination to investigate whether metabolic syndrome was related to hearing loss. METHODS: A total of 94,223 people who underwent health check-ups, including hearing tests, from January 2010 to December 2020 were evaluated. Subjects were divided into two groups, with and without metabolic syndrome. In addition, Scopus, Embase, PubMed, and Cochrane libraries were systematically searched, using keywords such as "hearing loss" and "metabolic syndrome", for studies that evaluated the relationship between the two. RESULTS: Of the 94,223 subjects, 11,414 (12.1%) had metabolic syndrome and 82,809 did not. The mean ages of subjects in the two groups were 46.1 and 43.9 years, respectively. A comparison of hearing thresholds by age in subjects with and without metabolic syndrome showed that the average pure tone hearing thresholds were significantly higher in subjects with metabolic syndrome than in subjects without it in all age groups. (p < 0.001) Rates of hearing loss in subjects with 0, 1, 2, 3, 4, and 5 of the components of metabolic syndrome were 7.9%, 12.1%, 13.8%, 13.8%, 15.5% and 16.3%, respectively, indicating a significant association between the number of components of metabolic syndrome and the rate of hearing loss (p < 0.0001). The odds ratio of hearing loss was significantly higher in subjects with four components of metabolic syndrome: waist circumference, blood pressure, and triglyceride and fasting blood sugar concentrations (p < 0.0001). CONCLUSIONS: The number of components of the metabolic syndrome is positively correlated with the rate of sensorineural hearing loss.

Role of Wnt signaling pathway in progression of sinonasal inverted papilloma to squamous cell carcinoma.

BACKGROUND: Sinonasal inverted papilloma (IP) is one of the most common benign tumors of the sinonasal area and malignant transformation has frequently been reported. However, the exact mechanism of the transition from benign lesion to malignancy is not known. The Wnt signaling pathway involves a network of multiple signaling glycoproteins that are known to play an important role in embryogenesis and carcinogenesis. OBJECTIVE: The purpose of this study was to evaluate the role of the Wnt pathway and signaling proteins in malignant transformation of IP to dysplasia and squamous cell carcinoma. METHODS: Expression of the Wnt signaling pathway proteins, including Wnt-1, beta-catenin, cyclin D1, and Dishevelled-1 (Dvl-1), were detected by immunohistochemistry by using 3-mm tissue core microarrays that consisted of 115 cores of IP tissue. Each of the IP cores was graded as I (prominent squamous metaplasia), II (inverted pattern), III (dysplasia), or IV (squamous cell carcinoma). The expression pattern of each protein and the correlation between the expression of each target protein and IP grade were evaluated. RESULTS: Membranous staining of beta-catenin showed a significant positive correlation with IP grade (ρ = 0.247, p < 0.001), as did staining of cyclin D1 (ρ = 0.365, p < 0.001), which showed a nuclear pattern and staining of Dvl-1 (ρ = 0.380, p < 0.001), which showed a membranous, cytoplasmic, and nuclear pattern. For Dvl-1, a nuclear expression pattern was more frequently observed in grade III and IV IP (p = 0.036). In the case of Wnt-1, cytoplasmic expression was observed; however, it did not show a significant correlation with IP grade (ρ = 0.141, p = 0.130). CONCLUSIONS: Wnt signaling proteins, including beta-catenin, cyclin D1, and Dvl-1, may play crucial roles in the malignant transformation of IP.

Hearing loss as a function of aging and diabetes mellitus: a cross sectional study.

BACKGROUND: Although hearing loss may be caused by various factors, it is also a natural phenomenon associated with the aging process. This study was designed to assess the contributions of diabetes mellitus (DM) and hypertension, both chronic diseases associated with aging, as well as aging itself, to hearing loss in health screening examinees. METHODS: This study included 37,773 individuals who underwent health screening examinations from 2009 to 2012. The relationships between hearing threshold and subject age, hearing threshold at each frequency based on age group, the degree of hearing loss and the presence or absence of hypertension and DM were evaluated. RESULTS: The prevalence of hearing loss increased with age, being 1.6%, 1.8%, 4.6%, 14.0%, 30.8%, and 49.2% in subjects in their twenties, thirties, forties, fifties, sixties, and seventies, respectively (p<0.05). Hearing value per frequency showed aging-based changes, in the order of 6000, 4000, 2000, 1000 and 500 Hz, indicating greater hearing losses at high frequencies. The degree of hearing loss ranged from mild to severe. Aging and DM were correlated with the prevalence of hearing loss (p<0.05). There was no statistically significant association between hearing loss and hypertension after adjusting for age and DM. CONCLUSIONS: The prevalence of hearing loss increases with age and the presence of DM. Hearing loss was greatest at high frequencies. In all age groups, mild hearing loss was the most common form of hearing loss.

FgFlbD regulates hyphal differentiation required for sexual and asexual reproduction in the ascomycete fungus Fusarium graminearum.

Fusarium graminearum is a filamentous fungal plant pathogen that infects major cereal crops. The fungus produces both sexual and asexual spores in order to endure unfavorable environmental conditions and increase their numbers and distribution across plants. In a model filamentous fungus, Aspergillus nidulans, early induction of conidiogenesis is orchestrated by the fluffy genes. The objectives of this study were to characterize fluffy gene homologs involved in conidiogenesis and their mechanism of action in F. graminearum. We characterized five fluffy gene homologs in F. graminearum and found that FlbD is the only conserved regulator for conidiogenesis in A. nidulans and F. graminearum. Deletion of fgflbD prevented hyphal differentiation and the formation of perithecia. Successful interspecies complementation using A. nidulans flbD demonstrated that the molecular mechanisms responsible for FlbD functions are conserved in F. graminearum. Moreover, abaA-wetA pathway is positively regulated by FgFlbD during conidiogenesis in F. graminearum. Deleting fgflbD abolished morphological effects of abaA overexpression, which suggests that additional factors for FgFlbD or an AbaA-independent pathway for conidiogenesis are required for F. graminearum conidiation. Importantly, this study led to the construction of a genetic pathway of F. graminearum conidiogenesis and provides new insights into the genetics of conidiogenesis in fungi.

WetA is required for conidiogenesis and conidium maturation in the ascomycete fungus Fusarium graminearum.

Fusarium graminearum, a prominent fungal pathogen that infects major cereal crops, primarily utilizes asexual spores to spread disease. To understand the molecular mechanisms underlying conidiogenesis in F. graminearum, we functionally characterized the F. graminearum ortholog of Aspergillus nidulans wetA, which has been shown to be involved in conidiogenesis and conidium maturation. Deletion of F. graminearum wetA did not alter mycelial growth, sexual development, or virulence, but the wetA deletion mutants produced longer conidia with fewer septa, and the conidia were sensitive to acute stresses, such as oxidative stress and heat stress. Furthermore, the survival rate of aged conidia from the F. graminearum wetA deletion mutants was reduced. The wetA deletion resulted in vigorous generation of single-celled conidia through autophagy-dependent microcycle conidiation, indicating that WetA functions to maintain conidial dormancy by suppressing microcycle conidiation in F. graminearum. Transcriptome analyses demonstrated that most of the putative conidiation-related genes are expressed constitutively and that only a few genes are specifically involved in F. graminearum conidiogenesis. The conserved and distinct roles identified for WetA in F. graminearum provide new insights into the genetics of conidiation in filamentous fungi.

AbaA regulates conidiogenesis in the ascomycete fungus Fusarium graminearum.

Fusarium graminearum (teleomorph Gibberella zeae) is a prominent pathogen that infects major cereal crops such as wheat, barley, and maize. Both sexual (ascospores) and asexual (conidia) spores are produced in F. graminearum. Since conidia are responsible for secondary infection in disease development, our objective of the present study was to reveal the molecular mechanisms underlying conidiogenesis in F. graminearum based on the framework previously described in Aspergillus nidulans. In this study, we firstly identified and functionally characterized the ortholog of AbaA, which is involved in differentiation from vegetative hyphae to conidia and known to be absent in F. graminearum. Deletion of abaA did not affect vegetative growth, sexual development, or virulence, but conidium production was completely abolished and thin hyphae grew from abnormally shaped phialides in abaA deletion mutants. Overexpression of abaA resulted in pleiotropic defects such as impaired sexual and asexual development, retarded conidium germination, and reduced trichothecene production. AbaA localized to the nuclei of phialides and terminal cells of mature conidia. Successful interspecies complementation using A. nidulans AbaA and the conserved AbaA-WetA pathway demonstrated that the molecular mechanisms responsible for AbaA activity are conserved in F. graminearum as they are in A. nidulans. Results from RNA-sequencing analysis suggest that AbaA plays a pivotal role in conidiation by regulating cell cycle pathways and other conidiation-related genes. Thus, the conserved roles of the AbaA ortholog in both A. nidulans and F. graminearum give new insight into the genetics of conidiation in filamentous fungi.

A phenome-based functional analysis of transcription factors in the cereal head blight fungus, Fusarium graminearum.

Fusarium graminearum is an important plant pathogen that causes head blight of major cereal crops. The fungus produces mycotoxins that are harmful to animal and human. In this study, a systematic analysis of 17 phenotypes of the mutants in 657 Fusarium graminearum genes encoding putative transcription factors (TFs) resulted in a database of over 11,000 phenotypes (phenome). This database provides comprehensive insights into how this cereal pathogen of global significance regulates traits important for growth, development, stress response, pathogenesis, and toxin production and how transcriptional regulations of these traits are interconnected. In-depth analysis of TFs involved in sexual development revealed that mutations causing defects in perithecia development frequently affect multiple other phenotypes, and the TFs associated with sexual development tend to be highly conserved in the fungal kingdom. Besides providing many new insights into understanding the function of F. graminearum TFs, this mutant library and phenome will be a valuable resource for characterizing the gene expression network in this fungus and serve as a reference for studying how different fungi have evolved to control various cellular processes at the transcriptional level.

Influence of intranasal epinephrine and lidocaine spray on olfactory function tests in healthy human subjects.

OBJECTIVE: Although topical decongestants and anesthetics are widely used in preparation for nasal endoscopy, no controlled trials have evaluated the effects of these agents on olfaction. STUDY DESIGN: Randomized double-blinded controlled trial. SETTING: Tertiary referral hospital. MATERIALS AND METHODS: The authors recruited 72 healthy subjects and randomly assigned them to 1 of 4 groups (control, phenylephrine group, lidocaine group, and both agents). After baseline tests with the Korean version of Sniffin' Stick Test II (KVSS II), topical agents were applied to each nostril. Fifteen minutes later, repeat tests were carried out. Pre- and postspray results of the olfactory tests were compared, and the differences among groups were analyzed. RESULTS: The mean ± SD prespray KVSS II score of the study group was 30.2 ± 3.8, and there were no statistically significant differences among the study groups (P = .353). Mean ± SD pre- and postspray KVSS II scores were 29.0 ± 3.5 and 30.7 ± 3.7 (P = .128) in the control group, 30.6 ± 3.6 and 31.7 ± 3.3 (P = .262) in the phenylephrine group, and 31.4 ± 3.6 and 32.1 ± 3.1 (P = .557) in the lidocaine group, respectively. In the phenylephrine and epinephrine spray group, the mean ± SD pre- and postspray scores were 29.9 ± 4.4 and 31.3 ± 3.7 (P = .071), respectively. CONCLUSIONS: Neither topical intranasal phenylephrine nor lidocaine use affected the results of the olfactory test, even when the agents were used in combination.

Objective usefulness of thin silastic septal splints after septal surgery.

BACKGROUND: Silastic splints have been used as effective tools for septal support, avoiding adhesion, and mucosal healing after septal surgery. Furthermore, although many surgeons insert septal splints, no well-designed trials exist to support their use. A randomized double-blinded controlled trial was performed. METHODS: We recruited 40 subjects who had undergone septoplasty only without sinus surgery or turbinoplasty. A silastic septal splint was inserted in one side of the nasal cavity at the end of each septoplasty, with the other side serving as a control. The splint side and control side were randomly selected. Nasal discomfort score (10-point scale) and mucosal status (grades 1-4) were surveyed in a blinded setting on postoperative days 7 and 14. RESULTS: Forty of 83 subjects fulfilled the enrollment criteria. On the 7th postoperative day there was no significant difference in nasal discomfort between the splint and control sides (6.2 ± 1.28 and 5.7 ± 1.27, respectively; p = 0.116), but the mucosal status was better on the splint side than on the control side (1.5 ± 0.51 and 2.5 ± 0.85; p < 0.001). At 14 days postoperatively, the symptom score (2.7 ± 1.06 versus 3.8 ± 1.25; p < 0.001) and mucosal status (1.5 ± 0.55 versus 1.9 ± 0.68; p = 0.013) were significantly better on the splint side compared with the control side. CONCLUSION: Insertion of a silastic septal splint after septal surgery should be accepted as a routine procedure.

Sclerotherapy of branchial cleft cysts using OK-432.

OBJECTIVES: OK-432 has been widely used to treat lymphangioma and ranula; however, there are few studies for its use in treatment of branchial cleft cyst (BCC). We conducted this study to evaluate the effectiveness of sclerotherapy using OK-432 in treatment of BCC. STUDY DESIGN AND SETTING: Case series with planned data collection. SUBJECTS AND METHODS: From 2004 to 2007, we treated 23 patients with BCC using OK-432 sclerotherapy. Of these 23 patients, 18 had unilocular cysts and five had multilocular cysts. The sizes of the BCCs were measured and compared before and after treatment. RESULTS: Of the 23 cases, 14 (60.8%) showed complete regression; all of these were unilocular cysts. Of the remaining individuals with unilocular cysts, only one patient failed to show any response. This individual subsequently underwent surgical excision. A total of five patients with multilocular cysts showed no or partial response and subsequently underwent surgical excision. Minor adverse effects including fever and local pain were reported by 13 (56.5%) patients. CONCLUSION: These results suggest that sclerotherapy using OK-432 is an effective and safe treatment modality for BCC, especially for unilocular cysts. Sclerosing of unilocular BCC with OK-432 should therefore be considered before surgical excision.

Computed tomographic assessment of chronic rhinosinusitis with asthma.

BACKGROUND: The purpose of this study was to investigate differences in the extent of disease in patients with chronic rhinosinusitis (CRS) both with and without asthma. METHODS: Medical records and computed tomographic (CT) scans of 48 consecutive asthmatic patients and 523 nonasthmatic patients with CRS between April 1995 and December 2001 were reviewed, retrospectively. Each sinus in the ostiomeatal complex CT scans was assigned a score of 0-2 according to the extent of disease using the Lund-Mackay scoring system, and the ratios of the score of each sinus to the total score were analyzed for the difference between the asthmatic and nonasthmatic groups. A Mann-Whitney test was used for statistical evaluation, with p < 0.05 accepted as statistically significant. RESULTS: The ratios of ethmoid sinus score to total score were higher in asthmatic patients than in nonasthmatic patients (p < 0.001), and the ratios of the score of maxillary sinus to total score were lower in asthmatic patients than in nonasthmatic patients (p < 0.001). CONCLUSION: Our study shows that the ethmoid sinus is the preferred site of CRS in patients with coexisting asthma.

Clinical characteristics of chronic rhinosinusitis with asthma.

OBJECTIVE: This study was directed at identifying clinical features of chronic rhinosinusitis with asthma, and examining the differences of the postoperative outcomes in asthmatics and nonasthmatics. STUDY DESIGN AND SETTING: Twenty-one asthmatic and 77 nonasthmatic patients who underwent functional endoscopic sinus surgery (FESS) were entered into the study. The following six parameters were determined in asthmatic and nonasthmatic groups; the presence of allergy, previous sinus surgery, severity of preoperative rhinosinusitis symptoms, improvements in postoperative rhinosinusitis symptoms, preoperative disease extent, and postoperative endoscopic outcomes. RESULTS: Symptom scores improved significantly in both asthmatics and nonasthmatics postoperatively, and asthmatics exhibited significantly worse postoperative endoscopic outcomes compared with nonasthmatics. No difference was found in other parameters between two groups. Multivariate analysis revealed asthma continues to be an independent predictor of success. CONCLUSIONS: The present study found that chronic rhinosinusitis in asthmatics showed worse postoperative outcomes than in nonasthmatics, and every attempt should be made for the improvement of surgical results in these patients.

Tuberculous otitis media: a clinical and radiologic analysis of 52 patients.

OBJECTIVE: This retrospective study reports on the clinical and radiologic features and the treatment outcomes of patients with tuberculous otitis media (TOM). METHODS: We reviewed the medical records of 52 patients (53 ears) with TOM between 1993 and 2005 and analyzed temporal bone computed tomography scans of 23 patients. The diagnosis of TOM was made if a specimen of the middle ear revealed the presence of acid fast bacilli (AFB), grew Mycobacterium tuberculosis (M. Tb) on a culture, revealed characteristic histology, and/or was positive for polymerase chain reaction (PCR) for M. Tb. RESULTS: The highest incidence of the disease was observed among patients in their 30s. The main symptom was otorrhea, and the duration of symptoms was shorter than with nonspecific chronic otitis media. Most patients demonstrated a moderate to severe hearing loss. Five patients (9.6%) demonstrated a peripheral-type facial palsy. Temporal bone CT scans demonstrated relatively well-pneumatized mastoids and occupation by soft tissue of the entire tympanum and mastoid air cells. Six patients demonstrated bone destruction that involved the cortex of the mastoid bone. In most patients, antituberculous medication was effective treatment. The patients who underwent chemotherapy after surgery achieved more rapid healing of the ear and more frequent closure of the tympanic membrane than those who did not receive surgery. CONCLUSIONS: Clinicians should have a high index of suspicion and be aware of the clinical and radiologic characteristics of TOM.

The prognostic value of telomerase expression in peripheral blood mononuclear cells of head and neck cancer patients.

OBJECTIVE: This study investigates the expression of telomerase in the peripheral blood mononuclear cells (PBMCs) of head and neck cancer patients and the relationship between the telomerase expression in PBMCs and clinicopathological features with prognosis. METHODS: Peripheral blood samples were collected from 100 head and neck squamous cell cancer patients and 20 normal control group. The telomerase activity in peripheral blood mononuclear cells was measured by telomerase rapid amplification protocol (TRAP) assay using TRAPeze telomerase detection kit. Pearson chi test was used to analyze the correlation of telomerase expression with clinicopathologic parameters. Kaplan-Meier method and Cox proportional hazards model were used for prognostic analysis. RESULTS: Regarding the expression of telomerase in PBMCs of patients, 73 out of 100 (73.0%) were found to be positive, and the remaining 27 cases (27.0%) were negative. The difference to the telomerase expression of PBMCs in the normal and cancer patients was significant (P < 0.001). The expression of telomerase in PBMCs of patients was significant correlated with T classification (P = 0.005), N classification (P = 0.002), and AJCC stages (P < 0.001). On multivariate analysis, N classification (P = 0.007), AJCC stages (P = 0.02), and telomerase expression (P = 0.017) showed independent factors associated with poor survival. CONCLUSION: The detection of telomerase expression in PBMCs of head and neck cancer patients is a simple and very useful molecular marker for the progression and prognosis of head and neck cancer.