Novel Effect of Hyaluronan and Proteoglycan Link Protein 1(HAPLN1) on Hair Follicle Cells Proliferation and Hair Growth

Hair loss is a common condition that can have a negative impact on an individual’s quality of life. The severe side effects and the low efficacy of current hair loss medications create unmet needs in the field of hair loss treatment. Hyaluronan and Proteoglycan Link Protein 1 (HAPLN1), one of the components of the extracellular matrix, has been shown to play a role in maintaining its integrity. HAPLN1 was examined for its ability to impact hair growth with less side effects than existing hair loss treatments. HAPLN1 was predominantly expressed in the anagen phase in three stages of the hair growth cycle in mice and promotes the proliferation of human hair matrix cells. Also, recombinant human HAPLN1 (rhHAPLN1) was shown to selectively increase the levels of transforming growth factor-β receptor II in human hair matrix cells. Furthermore, we observed concomitant activation of the ERK1/2 signaling pathway following treatment with rhHAPLN1. Our results indicate that rhHAPLN1 elicits its cell proliferation effect via the TGF-β2-induced ERK1/2 pathway. The prompt entering of the hair follicles into the anagen phase was observed in the rhHAPLN1-treated group, compared to the vehicle-treated group. Insights into the mechanism underlying such hair growth effects of HAPLN1 will provide a novel potential strategy for treating hair loss with much lower side effects than the current treatments.

A Novel Role of Hyaluronic Acid and Proteoglycan Link Protein 1(HAPLN1) in Delaying Vascular Endothelial Cell Senescence

Cardiovascular diseases (CVDs) are the most common cardiovascular system disorders. Cellular senescence is a key mechanism associated with dysfunction of aged vascular endothelium. Hyaluronic acid and proteoglycan link protein 1 (HAPLN1) has been known to non-covalently link hyaluronic acid (HA) and proteoglycans (PGs), and forms and stabilizes HAPLN1-containing aggregates as a major component of extracellular matrix. Our previous study showed that serum levels of HAPLN1 decrease with aging. Here, we found that the HAPLN1 gene expression was reduced in senescent human umbilical vein endothelial cells (HUVECs). Moreover, a recombinant human HAPLN1 (rhHAPLN1) decreased the activity of senescence-associated β-gal and inhibited the production of senescence-associated secretory phenotypes, including IL-1β, CCL2, and IL-6. rhHAPLN1 also downregulated IL-17A levels, which is known to play a key role in vascular endothelial senescence. In addition, rhHAPLN1 protected senescent HUVECs from oxidative stress by reducing cellular reactive oxygen species levels, thus promoting the function and survival of HUVECs and leading to cellular proliferation, migration, and angiogenesis. We also found that rhHAPLN1 not only increases the sirtuin 1 (SIRT1) levels, but also reduces the cellular senescence markers levels, such as p53, p21, and p16. Taken together, our data indicate that rhHAPLN1 delays or inhibits the endothelial senescence induced by various aging factors, such as replicative, IL-17A, and oxidative stress-induced senescence, thus suggesting that rhHAPLN1 may be a promising therapeutic for CVD and atherosclerosis.

Diagnostic imaging findings of subcutaneous mast cell tumor in a dog

A 5-year-old Labrador Retriever presented with a subcutaneous mass on the right scapular region with localized calor. On magnetic resonance imaging (MRI), a heterogeneously hypointense mass was seen on T1-weighted images (WI) and hyperintense on T2WI and fat-suppressed T2WI with marginal contrast enhancement on postcontrast T1WI and invasion into the surrounding tissue. Histopathological examination of the mass confirmed subcutaneous mast cell tumor (MCT) infiltrating to the adjacent subcutaneous fat. This is the first report to describe the MRI findings of subcutaneous MCT in veterinary medicine. This study suggests that MRI may help evaluate the extent of invasion of subcutaneous MCT.

One-year survival in recipients older than 50 bridged to heart transplant with Impella 5.5 via axillary approach / 老年心脏病学杂志（英文版）

BACKGROUND@#Optimizing patients with advanced heart failure before orthotopic heart transplantation (OHT), especially in patients greater than 50 years old, is imperative to achieving successful post-transplant outcomes. Complications are well-described for patients bridged to transplant (BTT) with durable left ventricular assist device (LVAD) support. Given the lack of data available in older recipients after the recent increase in mechanical support use, we felt it crucial to report our center's one-year outcomes in older recipients after heart transplantation with percutaneously placed Impella 5.5 as a BTT.@*METHODS@#Forty-nine OHT patients were supported with the Impella 5.5 intended as a bridge between December 2019 and October 2022 at Mayo Clinic in Florida. Data were extracted from the electronic health record at baseline and during their transplant episode of care after Institutional Review Boards approval as exempt for retrospective data collection.@*RESULTS@#Thirty-eight patients aged 50 or older were supported with Impella 5.5 as BTT. Ten patients underwent heart and kidney transplantation within this cohort. The median age at OHT was 63 (58-68) years, with 32 male (84%) and six female patients (16%). Etiology was divided into ischemic (63%) and non-ischemic cardiomyopathy (37%). The baseline median ejection fraction was 19% (15-24). Most patients were in blood group O (60%), and 50% were diabetic. The average duration of support was 27 days (range 6-94). The median duration of follow-up is 488 days (185-693). For patients that have reached the 1-year follow-up timeframe (22 of 38, 58%), the 1-year post-transplant survival is 95%.@*CONCLUSION@#Our single-center data provides awareness for using the Impella 5.5 percutaneously placed axillary support device in older heart failure patients in cardiogenic shock as a bridge to transplantation. One-year survival outcomes after heart transplantation are excellent despite the older recipient's age and prolonged pre-transplant support.

Structural Insights for β-Lactam Antibiotics

Antibiotic resistance has emerged as a global threat to modern healthcare systems and has nullified many commonly used antibiotics. β-Lactam antibiotics are among the most successful and occupy approximately two-thirds of the prescription antibiotic market. They inhibit the synthesis of the peptidoglycan layer in the bacterial cell wall by mimicking the D-Ala-D-Ala in the pentapeptide crosslinking neighboring glycan chains. To date, various β-lactam antibiotics have been developed to increase the spectrum of activity and evade drug resistance. This review emphasizes the three-dimensional structural characteristics of β-lactam antibiotics regarding the overall scaffold, working mechanism, chemical diversity, and hydrolysis mechanism by β-lactamases. The structural insight into various β-lactams will provide an in-depth understanding of the antibacterial efficacy and susceptibility to drug resistance in multidrug-resistant bacteria and help to develop better β-lactam antibiotics and inhibitors.

Acute cerebral infarction combined with a thyroid storm in a patient with both Moyamoya syndrome and Graves’ disease

Moyamoya syndrome (MMS) associated with hyperthyroidism, such as Graves’ disease, is a rare condition that causes ischemic stroke with thyrotoxicity. A 43-year-old woman with symptoms of right hemiparesis was admitted. Brain magnetic resonance imaging revealed a small cerebral infarction in the left frontal lobe. Cerebral angiography revealed multi-vessel intracranial occlusive disease. Several days later, neurologic deterioration and aggravation of cerebral infarction developed due to a thyroid storm. A thyroid function test revealed the following: thyroid-stimulating hormone (TSH) ＜0.01 μunits/mL (reference range, 0.55–4.78 μunits/mL); triiodo-thyronine ＞8.0 ng/mL (reference range, 0.77–1.81 ng/mL); free thyroxine (T4) of 9.47 pmol/L (reference range, 11.4–22.6 pmol/L); and TSH receptor antibody of 37.10 U/L (reference range, 0–10 U/L). For thyroid storm management, we initiated treatment with methimazole, Gemstein’s solution, and hydrocortisone. Finally, the thyroid disease was controlled, and neurologic deficits improved. We describe a case of acute cerebral infarction combined with a thyroid storm in a patient with Moyamoya syndrome and Graves’ disease. Hyperthyroidism such as Graves’ disease should be considered in the differential diagnosis for patho-etiologic mechanisms associated with MMS. A cerebrovascular disease with a thyroid storm can lead to severe mortality and morbidity. Prompt diagnosis and strict treatment are important.

Clinical outcomes in pediatric patients with normal renal histopathology

There have been some cases where abnormal histopathologic findings could not be found in the kidney could even with proper specimen collection through percutaneous renal biopsy (PRB) in accordance with its indication. We analyzed the incidence and clinical outcomes of children who showed normal histopathological findings in their PRBs. Methods: The medical records of 552 pediatric subjects who underwent PRB between 2005 and 2016 were reviewed. Twenty-six subjects were excluded because allograft biopsy was performed in nine subjects, and the age at biopsy was greater than 18 years in 17 subjects. Finally, 526 subjects were enrolled in this study. Results: Of the 526 pediatric patients, 32 (6.1%) showed no histopathological abnormalities in their PRBs. The male-to-female ratio of the patients was 1.9:1, and the mean ages at the first visit and at biopsy were 10.6 ± 4.1 and 11.4 ± 3.8 years, respectively. In accordance with the biopsy indications, recurrent gross hematuria showed the highest incidence rate, but combined hematuria and proteinuria had the lowest incidence rate regarding normal renal histopathology among all the subjects. At a mean follow-up of 35.5 ± 23.6 months, urinary abnormalities had improved in more than 50% of the subjects with normal renal histopathology, and none of the patients showed progression to end-stage renal disease or required rebiopsy due to symptom worsening during the follow-up period. Conclusion: The clinical outcomes of children with normal PRB histopathologic findings are generally good. Further studies to evaluate their long-term outcomes are needed.

Motor Weakness of Contralateral Upper and Lower Limbs in a Patient with Septic Arthritis of the Knee Combined with Infective Endocarditis: Embolic Infarction Due to Infective Endocarditis / 대한정형외과학회잡지

An 82-year-old man visited with fever and severe pain in the right knee. Septic arthritis was confirmed by magnetic resonance imaging (MRI) and joint fluid analysis, and the patient underwent arthroscopic synovectomy and received empirical antibiotic therapy. One day later, motor weakness of contralateral upper and lower limbs developed. Brain MRI confirmed embolic infarction and transthoracic echocardiography confirmed mitral valve infective endocarditis. This paper reports a case of motor weakness after arthroscopic synovectomy for septic arthritis of the knee and provides a review of relevant literature regarding infective endocarditis.

The Effect of Locally Administered Fibrinolytic Drugs Following Aneurysmal Subarachnoid Hemorrhage : A Meta-Analysis with Eight Randomized Controlled Studies

Objective@#: Rapid dissolution of blood clots reduces vasospasm and hydrocephalus after subarachnoid hemorrhage (SAH), and locally administered fibrinolytic drugs (LAFDs) could facilitate the dissolution. However, the efficacy of LAFDs remains controversial. The aim of this meta-analysis was to determine the efficacy of LAFDs for vasospasm and hydrocephalus and in clinical outcomes. @*Methods@#: From PubMed, EMBASE, and Cochrane database, data were extracted by two authors. Meta-analysis was performed using a random effect model. Inclusion criteria were patients who had LAFDs with urokinase-type or recombinant tissue-plasminogen activator after SAH in comparison with medically untreated patients with fibrinolytic drugs. We only included randomized controlled trials (RCTs) in this analysis. The outcomes of interest were vasospasm, hydrocephalus, mortality, and 90-day unfavorable functional outcome. @*Results@#: Data from eight RCTs with 550 patients were included. Pooled-analysis revealed that the LAFDs were significantly associated with lower rates of vasospasm (LAFDs group vs. control group, 26.5% vs. 39.2%; odds ratio [OR], 0.48; 95% confidence interval [CI], 0.32–0.73); hydrocephalus (LAFDs group vs. control group, 26.0% vs. 31.6%; OR, 0.54; 95% CI, 0.32–0.91); and mortality (LAFDs group vs. control group, 10.5% vs. 15.7%; OR, 0.58; 95% CI, 0.34–0.99). The proportion of 90-day unfavorable outcomes was lower in the LAFDs group (LAFDs group vs. control group, 32.7% vs. 43.5%; OR, 0.55; 95% CI, 0.37–0.80). @*Conclusion@#: This meta-analysis with eight RCTs indicated that LAFDs were significantly associated with lower rates of vasospasm and hydrocephalus after SAH. Thus, LAFDs could consequently reduce mortality and improve clinical outcome after SAH.

Hypertrophic pyloric gastropathy with Helicobacter spp. in a dog

A 12-year-old, castrated male, mixed dog presented with a history of gradual abdominal distention for a year and anorexia recently, with abdominal radiographs showing a gastric pylorus distention. A solitary, pedunculated, heterogeneous mass arising from the mucosal layer in the pylorus with intact wall layers was identified during ultrasound and computed tomography. The gastric muscular layer was evenly thick. After surgical excision of the mass, histological examination confirmed hypertrophic pyloric gastropathy with polypoid growth and Helicobacter spp. infiltrating the gastric mucosal epithelium. This is the first reported diagnostic imaging case of hypertrophic pyloric gastropathy with Helicobacter spp. in a dog.

Radiographic evaluation of congenital vertebral anomalies in Korean raccoon dogs (Nyctereutes procyonoides koreensis)

Background@#The normal vertebral anatomy of Korean raccoon dogs and their variants require research attention as a prerequisite for identifying pathologies and anomalies. @*Objectives@#This retrospective study aimed at describing the vertebral formula and congenital vertebral anomalies in Korean raccoon dogs (Nyctereutes procyonoides koreensis). @*Methods@#Radiographs of 82 raccoon dogs (42 males, 40 females) acquired from May 2013 to June 2020 in the Gangwon Wildlife Medical Rescue Center were reviewed to evaluate the cervical, thoracic, and lumbar vertebrae of the spine. @*Results@#Normal morphology of all vertebrae was observed in 50 of the 82 raccoon dogs, and the vertebral formula was cervical 7, thoracic 13, and lumbar 7. Congenital vertebral anomalies were found in 32 raccoon dogs: transitional vertebrae (TV) in 31 and block vertebrae in 2. Two raccoon dogs had 2 types of vertebral anomalies: one had TV and block vertebra, and the other had 2 types of TV. Twenty-nine raccoon dogs had thoracolumbar TV (TTV) and 3 had lumbosacral TV. TTV was morphologically classified into 4 different types:unilateral extra-rib in 5 raccoon dogs, bilateral extra-ribs in 14, bilateral elongated transverse processes in 4, and an asymmetric mixed formation of extra-rib with elongated transverse process in 6. @*Conclusions@#This study showed that TTV is common in Korean raccoon dogs, and that the vertebral formula is relatively diverse. The bilateral extra-ribs type TTV is the most common variant, which is almost similar to normal rib to be confused the radiographic evaluation.

Balance impairment caused by diazepam in 2 dogs with vestibular disease: case reports

Following intravenous (IV) administration of diazepam as a preanesthetic agent, sudden balance impairment, such as falling, leaning, and rolling, was identified in 2 canine cases. The 2 dogs were anesthetized for brain magnetic resonance scan to diagnose about a history of head tilt. After end of the diagnostic procedures, during the anesthetic recovery period, balance impairment was also observed. However, the symptoms gradually ceased by IV administration of flumazenil. These 2 canine cases indicated that diazepam premedication was responsible for the acute balance impairment.

Comparison of Postoperative Complications between Simultaneous and Staged Surgery in Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy / 대한신경손상학회지

Objective@#Cranioplasty (CP) and ventriculoperitoneal shunt (VPS) are required procedures following decompressive craniectomy (DC) for craniofacial protection and to prevent hydrocephalus. This study assessed the safety and efficacy of simultaneous operation with CP and VPS after DC, and determined the preoperative risk factors for postoperative complications. @*Methods@#Between January 2009 and December 2019, 81 patients underwent CP and VPS in simultaneous or staged operations following DC. Cumulative medical records and radiologic data were analyzed using univariate analysis to identify factors predisposing patients to complications after CP and VPS. @*Results@#CP and VPS were performed as simultaneous or staged operations in 18 (22.2%) and 63 (77.8%) patients, respectively. The overall postoperative complication rate was 16.0% (13/81). Patients who underwent simultaneous CP and VPS were significantly more likely to experience complications when compared with patients who underwent staged operations (33.3% vs. 9.6%, p<0.01). Univariate analysis revealed that simultaneous CP and VPS surgery was the only significant predictor of postoperative complications (p=0.031). @*Conclusion@#This study provided detailed data on surgical timing and complications for CP and VPS after DC. We showed that simultaneous procedures were a significant risk factor for postoperative complications.

Hypertrophic pyloric gastropathy with Helicobacter spp. in a dog

A 12-year-old, castrated male, mixed dog presented with a history of gradual abdominal distention for a year and anorexia recently, with abdominal radiographs showing a gastric pylorus distention. A solitary, pedunculated, heterogeneous mass arising from the mucosal layer in the pylorus with intact wall layers was identified during ultrasound and computed tomography. The gastric muscular layer was evenly thick. After surgical excision of the mass, histological examination confirmed hypertrophic pyloric gastropathy with polypoid growth and Helicobacter spp. infiltrating the gastric mucosal epithelium. This is the first reported diagnostic imaging case of hypertrophic pyloric gastropathy with Helicobacter spp. in a dog.

Radiographic evaluation of congenital vertebral anomalies in Korean raccoon dogs (Nyctereutes procyonoides koreensis)

Background@#The normal vertebral anatomy of Korean raccoon dogs and their variants require research attention as a prerequisite for identifying pathologies and anomalies. @*Objectives@#This retrospective study aimed at describing the vertebral formula and congenital vertebral anomalies in Korean raccoon dogs (Nyctereutes procyonoides koreensis). @*Methods@#Radiographs of 82 raccoon dogs (42 males, 40 females) acquired from May 2013 to June 2020 in the Gangwon Wildlife Medical Rescue Center were reviewed to evaluate the cervical, thoracic, and lumbar vertebrae of the spine. @*Results@#Normal morphology of all vertebrae was observed in 50 of the 82 raccoon dogs, and the vertebral formula was cervical 7, thoracic 13, and lumbar 7. Congenital vertebral anomalies were found in 32 raccoon dogs: transitional vertebrae (TV) in 31 and block vertebrae in 2. Two raccoon dogs had 2 types of vertebral anomalies: one had TV and block vertebra, and the other had 2 types of TV. Twenty-nine raccoon dogs had thoracolumbar TV (TTV) and 3 had lumbosacral TV. TTV was morphologically classified into 4 different types:unilateral extra-rib in 5 raccoon dogs, bilateral extra-ribs in 14, bilateral elongated transverse processes in 4, and an asymmetric mixed formation of extra-rib with elongated transverse process in 6. @*Conclusions@#This study showed that TTV is common in Korean raccoon dogs, and that the vertebral formula is relatively diverse. The bilateral extra-ribs type TTV is the most common variant, which is almost similar to normal rib to be confused the radiographic evaluation.

Determining the composition of bacterial community and relative abundance of specific antibiotics resistance genes via thermophilic anaerobic digestion of sewage sludge.

In this study, the effects of different temperature transitions on the dynamics of antibiotic resistance genes (ARGs) and bacterial community were investigated during start-up of thermophilic anaerobic digestion (AD) of sewage sludge. Although two thermophilic reactors showed dissimilar removal efficiencies of ARGs in batch mode, both the removal efficiency and reduction patterns of ARGs were similar in continuous stirred tank reactor (CSTR) mode, resulting in significant reduction of the total sum of the relative abundance of ARGs. Using network analysis to explore the correlation between bacterial community and some specific ARGs revealed that composition of the bacterial community played a vital role in the fluctuations in the relative abundance of the antibiotic resistome, demonstrating that shaping the development of ARGs was facilitated by vertical gene transfer. To facilitate eliminating ARGs, minimizing their hosts which persist even under long-term operations is vital in thermophilic AD.

Incidence and Characteristics of Immediate Substitutions of Injured Players in Korean Professional Football League Matches / 대한스포츠의학회지

Purpose@#To identify the incidence and characteristics of immediate substitutions of injured players that occurred during Korean professional football league matches. @*Methods@#This study included injuries that resulted in immediate substitutions of injured players during Korean professional football league matches. The match broadcasting records were used to check the date of the match, home-away matches, the team to which players belong, the position on the field of play, and the time of injury.The match recording videos were used to evaluate the injury mechanism and the injured area. @*Results@#In 228 matches, 66 immediate substitutions of injured players occurred, with an incidence rate of 0.3 per match. Total number of substitutions due to injuries most frequently occurred in May, with 15 substitutions in 30 matches; however, after considering the number of substitutions per match in each month, November was the most severe month with 0.53 substitutions after injuries per match. Most frequently injured players were defenders (36.4%), followed by midfielders, forwards, and goalkeepers. Immediate substitutions of injured players took place 32 times in the first half and 34 times in the second half. 51.5% of all injuries were related to collisions, and injuries to the knee and thigh accounted for 45.5% of all injuries. @*Conclusion@#There were 66 immediate substitutions of injured players during a single season of the Korean professional football league, with 0.3 substitutions after injuries per match. To prevent and manage serious injuries that can occur during a football match, a thorough analysis of risk factors of injuries that lead to immediate substitution is required.

Neuroimaging-Based Deep Learning in Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder

Deep learning (DL) is a kind of machine learning technique that uses artificial intelligence to identify the characteristics of given data and efficiently analyze large amounts of information to perform tasks such as classification and prediction. In the field of neuroimaging of neurodevelopmental disorders, various biomarkers for diagnosis, classification, prognosis prediction, and treatment response prediction have been examined; however, they have not been efficiently combined to produce meaningful results. DL can be applied to overcome these limitations and produce clinically helpful results. Here, we review studies that combine neurodevelopmental disorder neuroimaging and DL techniques to explore the strengths, limitations, and future directions of this research area.

Trends in knee surgery research in the official journal of the Korean Knee Society during the period 1999–2018: a bibliometric review

Background@#We applied bibliometric tools to original articles published in the official journal of the Korean Knee Society between 1999 and 2018 to identify their characteristics related to knee surgery and to examine the changes in research trends in the last 20 years. @*Methods@#Over a 20-year period, 579 original articles were published in the journal Knee Surgery and Related Research (KSRR). We analyzed the title, keywords, and abstract of the article to analyze the research topics and assigned original articles to seven surgical categories as follows: total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), high tibial osteotomy (HTO), arthroscopy, surgery for cruciate ligament, revision surgery, and other surgery. To analyze the trends in research, we divided the study period into two equal parts of 10 years each, examined the percentage of articles in each decade, and analyzed topic trends using the growth rate. @*Results@#Among the original articles, 86 on the topic of non-surgery were excluded, and 493 original articles related surgical research were included. Articles related to surgery accounted for 85.2% of the total original articles published annually. By period, this was 85.6% in the first half and 84.8% in the late half (p = 0.76). A total of 493 original articles related to surgery, with the largest number of TKA-related research at 52.1%. In the study period, the largest increase in the percentage of articles was on the topic of HTO surgery, by 149%. The topics of UKA and revision surgery increased by 95.3% and 33.9%. The topic of TKA increased by 5.9% and the topic of surgery for cruciate ligament decreased by 18.7%. The topic of arthroscopy showed the largest decrease, by 47.6%. @*Conclusions@#The bibliometric findings of this study suggest that the majority of surgery-related original articles published in KSRR during the last 20 years involved research about TKA surgery, and the greatest relative increase over the study period involved research about HTO surgery. The authors expect that the analysis of characteristics and research trends of original articles published in KSRR will provide useful information about KSRR for future researchers.

Relationship between Increased Intracranial Pressure and Mastoid Effusion

Objective@#: This study aimed to assess the relationship between increased intracranial pressure (ICP) and mastoid effusions (ME). @*Methods@#: Between January 2015 and October 2018, patients who underwent intracranial surgery and had ICP monitoring catheters placed were enrolled. ICP was recorded hourly for at least 3 days. ME was determined by the emergence of opacification in mastoid air cells on follow-up brain imaging. C-reactive protein (CRP) levels, presence of endotracheal tube (ETT) and nasogastric tube (NGT), duration of intensive care unit (ICU) stay, duration of mechanical ventilator application, diagnosis, surgical modalities, and presence of sinusitis were recorded. Each factor’s effect on the occurrence of ME was analyzed by binary logistic regression analyses. To analyze the independent effects of ICP as a predictor of ME a multivariable logistic regression analysis was performed. @*Results@#: Total of 61 (53%) out of 115 patients had ME. Among the patients who had unilateral brain lesions, 94% of subject (43/50) revealed the ipsilateral development of ME. ME developed at a mean of 11.1±6.2 days. The variables including mean ICP, peak ICP, age, trauma, CRP, ICU stays, application of mechanical ventilators and presence of ETT and NGT showed statistically significant difference between ME groups and non-ME groups in univariate analysis. Sex and the occurrence of sinusitis did not differ between two groups. Adding the ICP variables significantly improved the prediction of ME in multivariable logistic regression analysis. @*Conclusion@#: While multiple factors affect ME, this study demonstrates that ICP and ME are probably related. Further studies are needed to determine the mechanistic relationship between ICP and middle ear pressure.