60 research outputs found
Trans-tympanic Cartilage Chip Insertion for Intractable Patulous Eustachian Tube
Background and Objectives: Patulous Eustachian tube (PET) causes troublesome autophony. We treated PET using tragal cartilage chip insertion to fill in the concavity within the tubal valve and evaluated the feasibility of this method. Subjects and METHODS: This study used a prospective design. Eleven patients with PET disorder were included. Tragal cartilage chip insertion via a transcanal approach into the Eustachian tube (ET) was performed in 14 ears of those patients. They were followed-up for at least 12 months after surgery and were evaluated by symptom questionnaire scores. RESULTS: The average follow-up was 16.4 months. Thirteen of fourteen ears received immediate complete relief of autophony symptoms. Autophony symptoms at the last follow-up were as follows: four ears (28.6%) had complete relief; five ears (35.7%) showed satisfactory improvement; four ears (28.6%) showed significant but unsatisfactory improvement; and one ear (7.1%) was unchanged. The PET symptom questionnaire in the affected ears showed a significant reduction in autophony (p=0.047) and improvement in breathing sound conduction (p=0.047). There were no complications such as otitis media or occlusion symptom. Conclusions: Transtympanic cartilage chip insertion into the ET provides a safe and accessible surgical option for the treatment of PET.ope
Study for pathogenesis of congenital cholesteatoma with comparison of proteins expressed in congenital cholesteatoma, acquired cholesteatoma and skin of the external auditory canal through proteomics
Dept. of Medicine/๋ฐ์ฌCongenital cholesteatomas are epithelial lesions which represent invasive growth and osteolysis. The incidence consists of 1-5 % in middle ear cholesteatoma, but the detection rate is increasing. Especially congenital cholesteatoma can make hearing function worse, when it is not properly managed. While the biochemical study of acquired cholesteatomas is progressed some degree, the pathogenesis of congenital cholesteatomas is nearly unknown. Therefore the biochemical study regarding it is necessary now. Considering limitations of genetic study, crossover analysis of proteins expressed in congenital cholesteatomas via proteomics and ELISA can give us some clue for the understanding of its pathogenesis and make progress in treatment for it.Four congenital cholesteatoma matrices, and four samples of normal external auditory canal skin and two acquired cholesteatoma were obtained intraoperatively. We performed 2D electrophoresis in order to separate the proteins by molecular weight and detected. We then analyzed the upregulated spots from the congenital cholesteatoma matrices comparing the acquired cholesteatoma specimens through MALDI-TOF MS and immunohistochemical staining.In the 2D electrophoresis, four samples of congenital cholesteatoma showed very similar pattern of proteins expression. Comparing protein expression of acquired cholesteatoma and congenital cholesteatoma, some proteins were simultaneously expressed and the others not. Similar and different components of protein expression between the skin and congenital cholesteatoma sample were identified. The total number of spots in the 2-DE image from congenital cholesteatoma, acquired cholesteatoma and the skin was 556, 460 and 624. In the congenital and acquired cholesteatoma 326 proteins were simultaneously expressed. Of them, 56 proteins were not expressed in the skin. In the skin and congenital
cholesteatoma 373 proteins were simultaneously expressed. Therefore 127 proteins were expressed only on congenital cholesteatoma. Major spots expressed in congenital cholesteatoma gels more than in acquired cholesteatoma gels were selected and analyzed, which included titin, PRO2619, forkhead transcription activator homolog, ryanodine receptor 2, plectin 1, keratin 10 and leucine zipper protein 5. Spots which were densitometrically expressed in congenital cholesteatoma gels more than spots of acquired cholesteatoma and were not expressed in the skin gels, were analyzed. They were nine spots, which were Ig heavy chain variable region (gi951281), chain A structure of human muscle pyruvate kinase (Pkm2, gi223462173). In immunostaining assay, forkhead transcription activator homolog (FKH 5-3), keratin-10 and titin in congenital cholesteatoma specimen was identified in contrast to the negative control.In this study, we found the proteins expressed in congenital cholesteatoma more than in acquired cholesteatoma. Among them, proteins which were not expressed in the skin were found. Some of them maybe play an important role in the pathogenesis of congenital cholesteatoma. But the function study for them should be continued.34810359) and cyclic nucleotide gated channel beta 3 (gi81170715), chain B crystal structure of human caspase-2 in complex with Acetyl-Leu-Asp-Glu-Ser-Asp-Cho (gi115298657), caspase-5/f (gi327532753), protein S100-A7 (gi119612656), DNA repair and recombination protein RAD54B isoform 3 (gi67464392), ribosomal protein L35a isoform CRA_c (giope
Tracheal reconstruction with a free vascularized myofascial flap: preclinical investigation in a porcine model to human clinical application
Although there are various methods for tracheal reconstruction, such as a simple approximation with suturing and coverage with adjacent soft tissue or muscle, large defectsโ>50% of the tracheal length still present a clinical challenge. Tissue engineering, a recent promising way to possibly resolve this problem, requires a long preparatory period for stem cell seeding on a scaffold and relatively invasive procedures for stem cell harvesting. As an alternative, we used a vascularized myofascial flap for tracheal reconstruction. In four porcine models, the deep inferior epigastric perforator (DIEP) was used in two and the superior epigastric artery perforator (SEAP) in two. Transformation of the surface of the transplanted myofascial flap was analyzed in the airway environment. The flaps failed in the DIEP group due to venous congestion. At 12 weeks postoperatively, none of SEAP group showed any signs of respiratory distress; the inner surface of the implant exhibited stratified squamous epithelium with sparse cilia. In the clinical setting, a patient who underwent a tracheal reconstruction with a vascularized myofascial flap and 2-year follow-up was in good health with no respiratory distress symptoms.ope
A Case of Merkel Cell Carcinoma of the External Auditory Canal Skin with Annulus and Tympanic Membrane
Merkel cell carcinoma is an extremely rare neuroendocrine neoplasm of the external auditory canal (EAC) skin, which requires wide excision and adjuvant radiation due to a high recurrence rate. In this report, we describe a case of Merkel cell carcinoma arising from the EAC which was successfully treated with endoscopic excision. A 32-years-old female patient with a history of papillary thyroid cancer was diagnosed with an EAC tumor incidentally. There was a erythematous papular lesion on the posterior EAC without any evidence of locoregional metastasis. The patient underwent endoscopic tumor resection under general anesthesia, and the final pathologic report confirmed the diagnosis of Merkel cell carcinoma. There was no clinical or radiographic evidence of recurrence or metastasis of Merkel cell tumor for 41 months after surgical resection alone.ope
The Time Course of Monocytes Infiltration After Acoustic Overstimulation
Cochlea macrophages regulate cochlea inflammation and may harbors the potentials to protect hearing function from injury, including acoustic overstimulation. Cochlea macrophage numbers increase at 3-7 days after acoustic stimulation. However, the exact timing of macrophage infiltration and maturation from inflammatory monocytes is unclear. Furthermore, neutrophils may also be involved in this process. Therefore, in this study, we investigated time-dependent immune cell infiltration, macrophage transformation, and neutrophil involvement following acoustic stimulation. Flow cytometry and immunofluorescence were conducted in C-X3-C motif chemokine receptor 1 (CX3CR1)+/GFP mice after acoustic overstimulation (at baseline and at 1, 2, 3, and 5 days after exposure to 120 dB for 1 h) to identify inflammatory monocytes in the cochlea. RNA-sequencing and quantitative polymerase chain reaction were performed to identify differentially expressed genes. Inflammatory monocytes infiltrated into the lower portion of the lateral wall within 2 days after acoustic overstimulation (dpn), followed by transformation into macrophages at 3-5 dpn via CX3CR1 upregulation and Ly6C downregulation. In addition, inflammatory monocytes were aggregated inside the collecting venule only at 1 dpn. Neutrophils were not a major type of phagocyte during this response. The gene encoding C-C motif chemokine ligand 2 gene was significantly upregulated as early as 3 h after acoustic overstimulation. Given these results, treatment to control immune response after a noise-induced hearing loss should be applied as soon as possible.ope
Inflammatory Monocytes Infiltrate the Spiral Ligament and Migrate to the Basilar Membrane After Noise Exposure
Objectives: Noise exposure leads to an increase in the macrophage population. This increment is thought to be caused by the transformation of infiltrated monocytes into macrophages rather than by proliferation of the cochlear resident macrophages. However, studies on infiltrated monocytes in the cochlea are scarce. Thus, we aimed to investigate the infiltration of monocytes and their transformation into macrophages after noise exposure.
Methods: In wild-type and CX3CR1+/GFP C57/B6 mice, inflammatory monocytes were identified by immunofluorescence of mouse cochlear cells. The findings were confirmed and quantitated by flow cytometry.
Results: One day after noise exposure, monocytes were identified in the spiral ligament. Flow cytometric analysis confirmed that the monocyte population peaked on post-noise exposure day 1 and decreased thereafter. On day 3 after noise exposure, amoeboid-type macrophages increased in the crista basilaris, and on day 5, they spread to the basilar membrane.
Conclusion: Infiltrated monocytes were successfully observed 1 day after noise exposure, preceding the increase in the macrophage population. This finding supports the proposal that infiltrated monocytes transform into macrophages.ope
๊ฐ์ธ์ฃผ์-์งํฉ์ฃผ์์ ๊ฐ์ธ์ฐจ๊ฐ ๊ฑฐ์ ํ๋์ ๋ฏธ์น๋ ์ํฅ
ํ์๋
ผ๋ฌธ(์์ฌ)--์์ธ๋ํ๊ต ๋ํ์ :์ฌ๋ฆฌํ๊ณผ ์ฌํ์ฌ๋ฆฌ์ ๊ณต,2002.Maste
Efficacy of drum graft with tragal cartilage and the coinsertion of PORP in the intact canal wall mastoidectom
์ํ๊ณผ/์์ฌ[ํ๊ธ]
ํ์ํ ์ ์๋์ญ๊ฐ์ ์ ์ํํ ํ, ๊ณ ๋ง์ ๊ณ ๋งํจ๋ชฐ์ด ๋ฐ์ํ๋ ๊ฒฝ์ฐ๊ฐ 5-20 %๊น์ง ๋ณด๊ณ ๋๊ณ ์๋ค. ์ด์ ๋ฐฉ์ง๋ฅผ ์ํด, ๋ง์ ์ ์๋ค์ด ์ฐ๊ณจ์ ์ฌ์ฉํ๊ณ ์๋ค. ๋ค์ํ ๋์์ธ์ ์ด์ฃผ์ฐ๊ณจ์ ์ด์ฉํ ๊ณ ์ค์ฑํ์ ์ด ์์ง๋ง ์ข๋ ๋์ ์ด๊ฐ์ฐ๊ณจ์ ๋์์ธ์ ์๊ฐํ๊ณ ์ ํ๋ค. ์ด์ฃผ์ฐ๊ณจ์ ์ญ์๋ก ํ์ ํ์ ๊ฐ๋์ฑ์ ์ฃผ๊ณ , ํ๊ธฐ๊ด ์ฝ์
์ ์ฉ์ดํ๊ฒ ํ๋ฉฐ ์ฐ๊ณจ์ ํฌํจํ์ฌ ๊ณ ๋งํจ๋ชฐ์ ๋ฐฉ์งํ๊ณ ๋ํ PORP๋ฅผ ์ฝ์
ํ์ฌ ์ฒญ๋ ฅ์ ์ฆ์ง์ ๊ฐ์ ธ์ค๊ณ , ๊ณ ๋งํจ๋ชฐ์ ์ญ์ ๋ฐฉ์งํ๋ ์ ์์ด๋ค. ์์ ์ ํ์ ๊ณ ๋ง ์ํ์ ์ฒญ๋ ฅ ๋ฑ์ ๋ณด๊ณ ๊ธฐ์กด์ ์ ์๋์ญ๊ฐ์ ํ์ ์ํ์ ๋น๊ตํ์ฌ ๋ณธ ์ ์์ ์ ์ฉ์ฑ์ ํ๊ฐํด ๋ณด๊ณ ์ ํ์๋ค.๊ณ ๋ง ์ด์์ผ๋ก ์ฐ๊ณจ-์ฐ๊ณจ๋ง ๋ณตํฉ์ฒด๋ฅผ ์ฌ์ฉํ๊ณ , ๋์์ PORP๋ฅผ ์ฝ์
ํ ์ด 47 ๋ก๋ฅผ ๋์์ผ๋ก ํ์๋ค. ์ด์ค 43 ๋ก์ ๋ํด ์ฒญ๋ ฅ ๊ฒ์ฌ๊ฐ ์ํ๋์๋ค. ์์ ์ ๊ฒฐ๊ณผ๋ ์์ ์ -ํ์ ์์์ฒญ๋ ฅ, ๊ณจ๊ธฐ๋์ฐจ, ๊ทธ๋ฆฌ๊ณ ์์ ํ ๊ณ ๋ง ์๊ฒฌ์ผ๋ก ํ๊ฐํ์๋ค. 20 ๋ก๊ฐ ๋จ์, 27๋ก๊ฐ ์ฌ์์์ผ๋ฉฐ, ๋์ด๋ 7๏ฝ71์ธ๊น์ง์ด๋ค. ์์ ํ ํ๊ท ์ถ์ ๊ด์ฐฐ ๊ธฐ๊ฐ์ 35๊ฐ์์ด๊ณ , ์์ ํ ์์์ฒญ๋ ฅ์ ์ ํ ํ๊ท 16๊ฐ์ ํ์ ์ํ๋์๋ค. ์ด 45๋ก ์ค 3๋ก (6.7%)์์ ๊ณ ๋งํจ๋ชฐ์ด ์ถ์ ๊ด์ฐฐ๊ธฐ๊ฐ ๋์ ๊ด์ฐฐ๋์์ผ๋ฉฐ ์ด์ธ์ PORP๊ฐ ์ฝ๊ฐ ๋์ถ์ด 1๋ก๊ฐ ์์๊ณ , ๊ณ ๋ง์ ์ธ์ธก ์น์ (lateral healing)๋ 1๋ก์ ์ ํ ๊ฐ์ผ๋ 2๋ก๊ฐ ์์๋ค. ํ๊ท ๊ณจ๊ธฐ๋์ฐจ๋ ํต๊ณํ์ ์ผ๋ก ์ ์ํ๊ฒ 30.0 dB์์ 24.0 dB๋ก (p<0.04) ๊ฐ์ํ์๊ณ , ํ๊ท ๊ธฐ๋์ฒญ๋ ฅ์ ํต๊ณํ์ ์ผ๋ก ์ ์ํ๊ฒ 47.3 dB(SD13.))์์ 35.7 dB(SD15.5)๋ก ๊ฐ์ ๋์๋ค.(p<0.0003)์ด์์ ๊ฒฐ๊ณผ๋ก ์๋ฆฌ์ ์ผ๋ก ๋์์ธ๋ ์ฐ๊ณจ-์ฐ๊ณจ๋ง ๋ณตํฉ์ฒด๋ฅผ ์ด์ฉํ ๊ณ ์ค์ฑํ์ ๊ณผ PORP์ ๋์ ์ฝ์
์ ๊ณ ๋งํจ๋ชฐ ๋ฐ์๊ณผ ๋ฌด๊ธฐํ๋ฅผ ํจ๊ณผ์ ์ผ๋ก ์ค์ผ ์ ์๊ณ , ์ฒญ๋ ฅ์ ๊ฐ์ ๋ ๊ธฐ๋ํ ์ ์๋ ์ ์์ผ๋ก ์ฌ๋ฃ๋๋ค. ์ฐ๊ณจ์ ๋์์ธ์ด ๊ณ ๋ง์ด์์ ์ฉ์ดํ๊ฒ ํด ์ฃผ๊ณ , ๊ณ ๋งํจ๋ชฐ์ด ๋ฐ์ํ๋๋ผ๋ ํ๊ธฐ๊ด์ ์ฝ์
ํ๊ธฐ ์ฝ๊ณ , PORP์ ๋์ถ์ ๋ฐฉ์งํ ์ ์๊ฒ ํด ์ค ๊ฒ์ด๋ค.
[์๋ฌธ]After performing intact canal wall mastoidectomy, formation of retraction pocket has been reported in 5~20% of the cases. To prevent this, many otologists have been using cartilage. Though there were various types of tympanoplasty, we would introduce the better design of tympanoplasty with tragal cartilage. The biologically designed cartilage which had cross-shaped groove was made to facilitate the manipulation so that the graft on tympanic ring could be easily performed. The groove of cartilage can be used later as a passage for ventilation tube insertion. And the insertion of PORP result in the improvement of hearing and the prevention of retraction pocket. We would evaluate the efficacy of the new tympanoplasty by comparing the reports of usual mastoidectomy with pre- and post-operative hearing and drum findingTotal 47 cases which were performed intact canal wall mastoidectomy with the insertion of PORP and drum graft using cartilage-perichondrial flap have been reviewed. Out of these, 43 cases have been selected to audiologic test. The result of operation was evaluated by comparing pre- and post-operative pure tone audiogram, air bone gap and postoperative drum findings. Twenty subjects were male and 27 female, aged from 7 to 71 years. Average follow up period after operation was 35months, and post-operative pure tone audiometry was conducted average 16 months after operation.Out of 45 cases, retraction pocket was observed in 3 cases (6.7%). Slight protrusion of PORP and lateral healing of drum was observed in 1 case each, and there were 2 cases of postoperative infection. Also number of cases with air bone gap less than 20 dB increased from 9(23%) cases pre-operation, to 20 cases (51%) post operation. Air bone gap average statistically decreased from 30.0 dB to 24.0 dB(p<0.04), and the mean air conduction thresholds statistically improved from a preoperative level of 47.3 dB (SD13.0) to a level of 35.7 dB(SD15.5)(p<0.0003)Biologically designed cartilage tympanoplasty with the co-insertion of PORP can decrease the formation of retraction pocket and atelectasis of drum as well as improving hearing. We assumed that the new cartilage-perichondrial flap facilitates the drum graft, and even if retraction pocket is formed, it is easier to insert the ventilation tube. Also it could prevent the extrusion of PORP.ope
The comparison of household health care expenditure and income elasticity by ability to pay levels
The purpose of this paper is to compare the amount of household health expenditures (HHE) and the proportion of health care expenditure to the household expenditure by ability to pay(ATP) levels. This study has focused on the influence of household ATP on HHE, estimating elasticity of health care expenditures for different ATP groups. For the empirical analysis, the Urban Households Survey Data of 2002 have been used. Our principal findings show that HHE are sensitive to changes in household ATP levels and that the group which is most responsive to changes in A TP level is the lower ATP group. These suggest that as households have less ATP, households with lower ATP reduce expenditures on health care in a proportional manner than those with higher ATP.ope
Dolomite ์ Fe-Si-Al ์ดํ์์ฐ๊ตฌ
MasterMagnesium consumption has grown considerably during the past decades due to its lightness and outstanding specific strength, which help industries reduce their energy consumption and environmental restriction. Most of the magnesium is worldwidely produced through Silicothermic reduction, or the so-called Pidgeon process, in which dolomite experiences a reduction process by the reducing agent of ferrosilicon. The Mg production of Silico-thermic reduction of dolomite requires a lot of energy consumption, and the production of ferrosilicon generates a large emission of carbon dioxide. Thus, this research explores the silico-alumino-thermic reduction of dolomite utilizing the commercially available, ferrosilicon-aluminum(Fe-Si-Al) as a reducing agent, hoping to reduce those faults involved in the Pidgeon process. The processing parameters of the aluminum/silicon ratio in Fe-Si-Al and the operation temperature were considered to evaluate the introduction of Al into Fe-Si as a reducing agent on the kinetics of MgO reduction. The ferrosilicon-aluminum reduction of MgO outweighed ferrosilicon reduction in terms of reduction kinetics and reduction ratio of MgO. The reduction reaction between dolomite and ferrosilicon-aluminum had thermodynamically a lower Gibbs free energy change of reaction than that between dolomite and ferrosilicon, resulting in a higher vapor pressure. Also, the decomposition temperature of ferrosilicon-aluminum mixed phase(880ยฐC) lower than the melting point of ferrosilicon(1210ยฐC), enhancing the reaction between solid(dolomite)/liquid(reducer) phases. The phases of ferrosilicon-aluminum according to the stoichmetry of aluminum/silicon were found to be a influencing parameter for the improvement on reduction capability
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