Comparison of voice following radiation therapy and conservation surgery in early glottic cancer

의학과/석사[한글] 조기 성문암의 치료로는 방사선치료와 보존적 수술이 있으며 그 치료 효과는 비슷하나 음성의 질에 대하여는 통일된 견해가 없는 실정이다. 또한 음성분석 방법이 객관적이지 못한 경우가 많고 후두 스트로보스코피에 의한 분석은 많지 않다. 저자는 1988년 1월부터 1998년 12월까지 신촌 세브란스 병원에서 T1, T2 조기 성문암으로 진단받은 환자들중 보존적 수술이나 방사선 치료중 한가지 치료를 받고 추적 관찰이 가능하였던 환자들을 대상으로 각 군의 환자에 대하여 컴퓨터를 이용한 음성분석으로 기본주파수, jitter, shimmer , noise to harmonic ratio 를 측정하고 최대발성지속시간과 평균호기류율, 후두 스트로보스코피 시행하였다. 41명의 남자 환자중 방사선 치료군은 22명이었고 수술군은 19명이었다. 기본주파수는 방사선 치료군에서 (평균 137.13Hz) 수술군보다 (평균 172.89Hz) 작은 값을 보였고, jitter는 방사선 치료군에서 (평균 4.17%) 수술군보다 (평균 5.41%) 작은 값을 보였다. shimmer역시 방사선 치료군에서 (평균 6.99%) 수술군보다 (평균 13.87%) 작은 값을 보였으며 noise to harmonic ratio도 방사선 치료군에서 (평균 0.20) 수술군보다 (평균 0.34) 작은 값을 보였다. 최대발성지속시간은 방사선 치료군에서 (평균 18.32초) 수술군보다 (평균 12.05초) 큰 값을 보였으며 평균호기류율은 방사선 치료군에서 (평균 148.86cc/sec) 수술군보다 (평균 223.47cc/sec) 작은 값을 보였다. 후두 스트로보스코피상 진동부분은 수술군중 병변쪽에서는 진동하는 부분이 없는 경우가 많았고 (19명중 10명) 병변반대쪽에서는 가성대가 진동하는 경우가 많았으며 (19명중 10명) 방사선 치료군에서는 진성대가 진동하는 경우가 많았다. (22명중 19명) 성문폐쇄부전은 수술군은 19명중 3명. 방사선 치료군은 22명중 1명으로 수술군에서 많았다. 피열연골의 과내전은 수술군에서 19명중 12명, 방사선 치료군은 22명중 1명으로 수술군에서 많았다. 성대의 발적, 부종은 수술군은 19명중 9명, 방사선치료군은 22명중 12명으로 방사선 치료군이 많았다. 음성분석 및 후두스트로보스코피 소견으로 볼 때 수술군은 방사선치료군에 비하여 성대의 진동이 불규칙하고 성대폐쇄부전이 심하였고 조직의 손실이 적은 방사선치료군이 조직의 손실이 큰 수술군보다 음성이 더 좋음을 알 수 있었다. [영문] The treatment of early glottic cancer is composed of radiotherapy and conservation surgery and the effects of two modality are similar. however, there is no consensus about the qualities of voice between two therapy. The methods of voice analysis were not objective and there are few stroboscopic analysis. So author performed the voice analysis and stroboscopy for the patients who were diagnosed and followed up early glottic cancer at Severance hospital from January 1988 to December 1998. The patients were managed with conservation surgery or radiotherapy. The voice analysis were composed of fundamental frequency, jitter, shimmer, noise to harmonic ratio, maximal phonation time, mean flow rate. Stroboscopy was done also. The results were as follows. All 41 men were divided with radiotherapy group(22men) and surgery group (19men). The fundamental frequency were smaller in radiation group (mean 137.13Hz) than surgery group (mean 172.89Hz) and jitter were smaller in radiation group (mean 4.17%) than surgery group (mean 5.41%). The shimmer were smaller in radiation group (6.99%) than surgery group (13.87%) and noise to harmonic ratio were smaller in radiation group (0.20) than surgery group (0.34). The maximal phonation time were longer in radiation group (18.32 sec) than surgery group (12.05sec) and mean flow rate were smaller in radiation group (148.86cc/sec) than surgery group (223.47cc/sec). On stroboscopic finding, vibration portion was none in many cases of surgery group affected side cord (10cases in 19cases) and supraglottis in many cases of surgery group unaffected side cord (10 cases in 19cases) and true vocal cord in many cases of radiation group (19cases in 22cases). Cord incompetences were many in surgery group (3 cases in 19 cases) than radiation group (1case in 22cases). Hyperadduction of arytenoid were many in surgery group (12cases in 19 cases) than radiation group (1 case in 22 cases). Hyperemia were many in radiation group (12cases in 22cases) than surgery group (9cases in 19cases). According to the voice analysis and stroboscopy, surgery group showed more irregular cord vibration and incompetence than radiation group. And the loss of tissue along the therapy suggested greater in surgery group than radiation group. In conclusion, the radiation group showed better voice quality than surgery group.ope

기도상피세포에서 17β-estradiol에 의한 MUC5B 유전자 발현의 신호전달

Dept. of Medicine/박사[한글] MUC5B는 사람의 호흡기에서 주요 점액 성분의 하나이나 여러 기도질환에서 그 발현의 조절기전은 잘 알려져 있지 않다. 본 연구에서는 estradiol이 어떤 기전을 통하여 사람 코점막상피세포와 NCI-H292 세포에서 MUC5B 유전자 발현을 유도하는지 알아보고자 하였다. 17β-estradiol (E2)은 성호르몬으로 estrogen receptor α (ERα)와 결합하여 ERK-MAP kinase (MAPK)를 통하여 MUC5B 유전자 발현을 자극하였다. E2와 함께 ER길항제인 ICI 182, 780을 투여하면 E2에 의해 유도되는 ERK-MAPK 활성과 MUC5B 유전자의 발현이 모두 억제되었다. E2는 주요 MAP kinase중 p38과 JNK는 활성화시키지 않았으나 ERK1/2는 활성화시켰고 MEK1 길항제인 PD98059를 투여하였을 때 E2에 의한 ERK1/2활성과 MUC5B mRNA발현이 모두 억제되었다. 또한 siRNA로 ERK1 이나 ERK2를 knockdown시켰을 때E2에 의한 ERK1, ERK2의 활성과 MUC5B mRNA발현이 모두 억제되었다. Ras와 Raf의 dominant-negative construct로 transient transfection 시킨 세포에서도 E2에 의한 ERK1/2의 활성과 MUC5B mRNA발현이 모두 억제되었다. siRNA로 RSK1을 knockdown시켰을 때 E2에 의한 MUC5B mRNA발현이 억제되었다. siRNA로 CREB을 knockdown시켰을 때 E2에 의한 MUC5B mRNA발현이 억제되었다.일련의 MUC5B promoter construct를 제작하여 luciferase assay를 시행한 결과, -956bp 에서 -649bp사이에 존재하는 cAMP-response element (CRE) site가 ERK-MAPK 를 통한MUC5B 유전자 발현에 중요하다는 것을 알 수 있었다. E2를 처리하였을 때CREB이 -956bp에서 -753bp사이의 MUC5B promotor에 결합하는 것을 ChIP assay를 통하여 확인할 수 있었다. CREB은 또한 CRE site에 CREB- binding protein (CBP) 과 steroid receptor coactivator-1 (SRC-1)과 함께 결합하여 histone acetrylation과 MUC5B 유전자 발현을 증가시켰다. 따라서 17β-estradiol은 기도상피세포에서 estrogen receptor, Ras, Raf, MEK1, ERK1/2 MAPK, RSK1로 신호가 전달되며 CREB이 CBP, SRC-1과 함께 MUC5B promoter에 결합하여 MUC5B 유전자 발현을 유도한다. [영문] MUC5B is a major mucin of the human respiratory tract, and it is not clear how MUC5B expression is regulated in various airway diseases. The goal of this study was to determine the mechanisms by which E2 induces MUC5B gene expression in airway epithelial cells. It was found that 17-estradiol (E2), a sex hormone, stimulate MUC5B gene overexpression by interaction with estrogen receptor (ER ) and by acting through ERK-MAP kinase (MAPK). Co-treatment with E2 and ER antagonist ICI 182,780 blocked both E2-induced ERK-MAPK activation and MUC5B gene expression. It was also found that the activation of p90 ribosomal S 6 protein kinase 1 (RSK1), cAMP-response element-binding protein (CREB) and cAMP-response element (CRE) (-956 region of the MUC5B promoter) responsive signaling cascades via ERK-MAPK are crucial at the mediation MUC5B gene expression. This study further showed that CREB was recruited to CRE together with CREB- binding protein (CBP) and steroid receptor coactivator-1 (SRC-1). This coincided with increased histone H3 acetylation (AcH3) and up-regulation of MUC5B gene expression. Taken together, these studies give additional insights into the molecular mechanism of hormone-induced MUC5B gene expression and enhance our understanding of abnormal mucin secretion in response to hormonal imbalances.ope

Epiglottic Collapse in Obstructive Sleep Apnea

Along with the development of diagnostic techniques, many studies have been conducted to find the anatomical causes of obstructive sleep apnea (OSA). The velum, oropharynx, tongue base, and epiglottis have been widely considered to be the common obstruction sites. However, the role of the epiglottis in sleep apnea is poorly understood compared to the other anatomical sites. The epiglottis causes OSA either alone or simultaneously with other obstruction sites. We have here reviewed the epidemiology, pathophysiology, diagnosis, and treatment of epiglottic collapse in patients with OSA based on the literature published to date

A Case of Grisel’s Syndrome After Tonsillectomy and Adenoidectomy

Grisel’s syndrome is an uncommon disease following the upper neck inflammatory process or ear, nose, and throat procedure. Clinically, it frequently develops in the pediatric population. The most common initial symptom is acute painful torticollis. This report presents a case of Grisel’s syndrome in an 8-year-old girl after tonsillectomy and adenoidectomy. CT was performed for diagnosis, and the patient was diagnosed with Grisel’s syndrome. Cervical halter traction was performed, and finally the patient recovered successfully without any complication

Review and Application of the Standards for Quality Improvement Reporting Excellence Guidelines in Korea

Globally, quality improvement (QI) activities are conducted in most health care institutions; however, results of QI activities are shared and communicated rather informally and often only among frontline practitioners. Unless QI activities, a cumulative experiential learning process in each healthcare institution, are shared widely through academic publication, scientific understanding in the QI field will remain a challenge. It was against this backdrop that in 2008 the Standards for QUality Improvement Reporting Excellence (SQUIRE) 1.0 was developed as a guideline for converting cases of QI activities to academic publications. Modifications and further developments in subsequent years led to a revised SQUIRE 2.0 in 2015. This review provides an overview of the development process of the SQUIRE 2.0 and the 18 major items, along with relevant examples for more concrete understanding. The SQUIRE 2.0 highlights the three basic elements involved in systematic efforts to improve quality of care, patient safety, and value: why a certain QI activity was conducted, what was found, and what was learned from it. The SQUIRE 2.0 is a guideline for reporting diverse methods used in QI activities that can be complex and multidimensional. Given that a large number of QI activities are reported in Korea each year in academic conferences, held by the Korean Society for Quality in Health Care and other professional societies, it is our hope that, by introducing the SQUIRE 2.0, this review can serve as a catalyst for converting QI activities to research studies and thereby for disseminating results of QI activities to a wider audience

한국 남성 수면무호흡 환자에서 설동맥과 혀의 위치관계 분석을 통한혀 기저부 기능 수술 시 안전 영역에 대한 연구

Background and Objectives Upon operation of the tongue base for obstructive sleep apneasyndrome (OSAS), the lingual artery and the hypoglossal nerve are put at risk of injury,resulting in fatal complications such as massive bleeding upon damage. We studied the courseof lingual artery in its relation with the tongue in OSAS patients and compared it with the ageand-gender-matched normal population. Subjects and Method Korean male patients confirmed with OSAS by polysomnography,including those who had contrast-enhanced computed tomography (ceCT) of the head andneck, were defined as “OSAS group.” Patients who had their ceCT image during the samestudy period were defined as the “control group.” The control group was paired with the OSASgroup by age and sex. By using foramen cecum (FC) as the main reference point, four referencemarks were defined. For each reference point, the distance between both lingual arteriesand the depth of the lingual artery from the lingual surface of the tongue were evaluated. Results The depth of the lingual artery from the lingual surface of the tongue in the OSASgroup (25.1±8.6 mm) was significantly different from the control (29.5±5.9 mm) at 1 cm anteriorto the FC level (p<0.014). The width of both lingual arteries was narrower in the OSASgroup (20.9±2.9) than in the control (24.3±6.1) at the FC level (p<0.003). Conclusion The course of lingual artery and its spatial relation with the tongue in Koreanmale OSAS patients differs from the matched normal population

Counter Clockwise Rotational Orthognathic Surgery for the Obstructive Sleep Apnea in Class II Dentofacial Deformity: Polysomnography and 3D Computed Tomographic Analysis

Traditionally, maxillomandibular advancement is an orthognathic surgical procedure that has been used to manage obstructive sleep apnea in patients not able or willing to maintain adherence to continuous positive airway pressure therapy or for patient who are not able to adhere to treatment. However, maxillomandibular advancement often leads to unsatisfactory cosmetic results.This prospective study investigated functional and esthetic outcomes using polysomnography and 3-dimensional computed tomography, after counterclockwise rotational orthognathic surgery. We enrolled 17 patients with obstructive sleep apnea, who underwent orthognathic surgery at single institution between March 2013 and December 2018.After 12 months, the patients' mean self-rated score for facial appearance, using a 10-step visual analog scale, was 7.36. The preoperative apnea-hypopnea index and respiratory disturbance index were 34.70 and 37.45, respectively; postoperative indices were 11.60 and to 12.69, respectively (P = 0.003, 0.003). The mean posterior pharyngeal airway space increased from 5357.88 mm3 preoperatively to 8481.94 mm3 after 6 postoperative months.Counterclockwise rotational orthognathic surgery for the correction of obstructive sleep apnea turned out to be the ideal solution not only in the correction of the sleep apnea, but also in the facial esthetics. Copyright ⓒ 2020 Wolters Kluwer Health, Inc. All rights reserved. Conflict of interest statement Conflicts of interest and sources of funding: This study was supported by a grant (2012-0676) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea. The authors declare no conflict of interest