Determinants of Conductive Hearing Loss in Tympanic Membrane Perforation

ObjectivesTympanic membrane perforations are common, but there have been few studies of the factors determining the extent of the resulting conductive hearing loss. The aims of this study were to determine whether the size of tympanic membrane perforation, pneumatization of middle ear & mastoid cavity, and location of perforation were correlated with air-bone gap (ABG) of patients.MethodsForty-two patients who underwent tympanoplasty type I or myringoplasty were included and preoperative audiometry were analyzed. Digital image processing was applied in computed tomography for the estimation of middle ear & mastoid pneumatization volume and tympanic membrane photograph for the evaluation of perforation size and location.ResultsPreoperative mean ABG increased with perforation size (P=0.018), and correlated inversely with the middle ear & mastoid volume (P=0.005). However, perforations in anterior versus posterior locations showed no significant differences in mean ABG (P=0.924).ConclusionThe degree of conductive hearing loss resulting from a tympanic membrane perforation would be expected with the size of perforation and pneumatization of middle ear and mastoid

Necrotizing sialometaplasia: a malignant masquerade but questionable precancerous lesion, report of four cases

Abstract Background Necrotizing sialometaplasia (NSM) is an extremely rare benign lesion with an uncertain pathogenesis. The differential diagnosis of this lesion is challenging due to little familiarity with this entity and histologic similarity with carcinomas, especially mucoepidermoid carcinoma (MEC). The purpose of this study is to raise awareness about NSM, which is often overlooked or misdiagnosed as malignancy in a small biopsy. Methods We reviewed all biopsy materials taken from the oral cavity in a single institution in Korea from 2012 to 2018 and found 4 cases of NSM out of 726. Clinicopathologic characteristics and comparison with other lesions were discussed. Results Unlike previous reports, patients in our series were relatively young, and NSM was not related to smoking and not associated with malignancies, although one patient was misdiagnosed with MEC on the basis of the initial biopsy. High-grade squamous dysplasia was observed in one patient; however, all four patients showed excellent prognoses without further management. Conclusions A conservative approach is recommendable for necrotizing lesions of the palate in young adults to avoid unnecessary treatment. However, careful monitoring is also required due to uncertainty of premalignant potential

Dissection Manual for Open Rhinoseptoplasty in a Silicone Nose Model

Open rhinoseptoplasty has been widely performed in the field of otorhinolaryngology. However, from the perspective of beginners, rhinoseptoplasty is a hard-to-learn surgery that involves a relatively steep learning curve. Therefore, practical guidance is essential to enhance the skills needed for excellent surgical outcomes. Here, we provide a step-wise dissection manual using a commercialized silicone nose model designed for rhinoseptoplasty. The contents include general approaches with regard to transcolumellar inverted V incision, flap elevation, osteotomy, septoplasty, modification of the lower lateral cartilage for tip surgery, and dorsal augmentation using silicone implants. In addition, we introduce novel techniques such as dorsal augmentation using a ready-made mold with tissue glue applied to diced cartilage and polycaprolactone mesh for rhinoseptoplasty. The present study also provides photos of individual surgical procedures using a silicone nose model for actual guidance. The authors expect that this manual will help beginning rhinoseptoplasty surgeons improve their confidence

Multilineage Potential of Stable Human Mesenchymal Stem Cell Line Derived from Fetal Marrow

Human bone marrow contains two major cell types, hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs). MSCs possess self-renewal capacity and pluripotency defined by their ability to differentiate into osteoblasts, chondrocytes, adipocytes and muscle cells. MSCs are also known to differentiate into neurons and glial cells in vitro, and in vivo following transplantation into the brain of animal models of neurological disorders including ischemia and intracerebral hemorrhage (ICH) stroke. In order to obtain sufficient number and homogeneous population of human MSCs, we have clonally isolated permanent and stable human MSC lines by transfecting primary cell cultures of fetal human bone marrow MSCs with a retroviral vector encoding v-myc gene. One of the cell lines, HM3.B10 (B10), was found to differentiate into neural cell types including neural stem cells, neurons, astrocytes and oligodendrocytes in vitro as shown by expression of genetic markers for neural stem cells (nestin and Musashi1), neurons (neurofilament protein, synapsin and MAP2), astrocytes (glial fibrillary acidic protein, GFAP) and oligodendrocytes (myelin basic protein, MBP) as determined by RT-PCR assay. In addition, B10 cells were found to differentiate into neural cell types as shown by immunocytochical demonstration of nestin (for neural stem cells), neurofilament protein and β-tubulin III (neurons) GFAP (astrocytes), and galactocerebroside (oligodendrocytes). Following brain transplantation in mouse ICH stroke model, B10 human MSCs integrate into host brain, survive, differentiate into neurons and astrocytes and induce behavioral improvement in the ICH animals. B10 human MSC cell line is not only a useful tool for the studies of organogenesis and specifically for the neurogenesis, but also provides a valuable source of cells for cell therapy studies in animal models of stroke and other neurological disorders

알레르기비염 마우스 모델에서 응고 및 섬유소용해계 인자의 발현양상 분석

학위논문 (석사)-- 서울대학교 대학원 : 의학과 이비인후과학 전공, 2016. 2. 김동영.Background : Dysregulation of the coagulation cascade and fibrinolysis system may play an etiologic role in many diseases. Allergic diseases such as bronchial asthma, atopic dermatitis, and conjunctivitis are also associated with fibrin accumulation caused by the change in hemostasis. Nevertheless there has been only a few studies dealing with the relation between allergic rhinitis (AR) and the coagulation system. Objective : This study was conduct to investigate the change of coagulation and fibrinolysis cascade components in allergic rhinitis murine model Methods : BALB/c mice were sensitized and challenged with ovalbumin. Multiple parameters related to coagulation cascade and fibrinolysis system such as Factor II, V, VII, X, XIII, tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA), plasminogen activator inhibitor-1 (PAI-1), and fibrin were compared between the allergic rhinitis model group and the control group. Results : The symptom scores and eosinophil counts were higher in the allergic rhinitis model group than the control group (p< .01). The mRNA expression level of u-PA (p= .040), PAI-1 (p= .054), Factor II (p= .038), Factor X (p= .036) was significantly higher in the allergic rhinitis model group. Most of the fibrinolysis system and coagulation cascade components were localized at the epithelium, endothelium and submucosal glands of the nasal mucosa on immunohistochemical staining and there was a down regulation of u-PA in AR group while fibrin deposition was much prominent in the AR model group. Conclusion : In allergic rhinitis condition, the coagulation cascade was up-regulated and the fibrinolysis system was down-regulated which seemed that the change of both components lead to fibrin deposition in allergic rhinitis mouse model.Introduction 1 Materials & Methods 2 Results 6 Discussion 8 Conclusions 11 References 24 Korean Abstract 26Maste

Iridium(III) complex-based phosphorescent and electrochemiluminescent dual sensor for selective detection of glutathione

Glutathione (GSH) is the most abundant biological thiol and involved in antioxidant defense systems in human cells. Lack of GSH increases the risk of oxidative stress, resulting in the progression of cancer. Therefore, a selective detection method for GSH is highly required. Herein, we report phosphorescent and electrochemiluminescent dual sensors (1-3) based on iridium complexes for the selective detection of GSH. These sensors have a 1,10-phenanthroline-5,6-dione (pdo) ancillary ligand as a common reaction site for GSH. Reduction of the pdo moiety to 1,10-phenanthroline-5,6-diol (phen(OH)2) upon reaction of sensors with GSH triggered fluorescence turn-on response and electrochemiluminescence turn-off response with high selectivity for GSH. Sensing mechanisms were elucidated by DFT calculations and cyclic voltammetry. Sensor 1 was successfully applied to determination of GSH concentrations in human serum samples by ECL methods.N

Predictive models of objective oropharyngeal OSA surgery outcomes: Success rate and AHI reduction ratio.

The aim of this study was to develop a predictive model of objective oropharyngeal obstructive sleep apnea (OSA) surgery outcomes including success rate and apnea-hypopnea index (AHI) reduction ratio in adult OSA patients.Retrospective outcome research.All subjects with OSA who underwent oropharyngeal and/or nasal surgery and were followed for at least 3 months were enrolled in this study. Demographic, anatomical [tonsil size (TS) and palate-tongue position (PTP) grade (Gr)], and polysomnographic parameters were analyzed. The AHI reduction ratio (%) was defined as [(postoperative AHI-preoperative AHI) x 100 / postoperative AHI], and surgical success was defined as a ≥ 50% reduction in preoperative AHI with a postoperative AHI < 20.A total of 156 consecutive OSAS adult patients (mean age ± SD = 38.9 ± 9.6, M / F = 149 / 7) were included in this study. The best predictive equation by Forward Selection likelihood ratio (LR) logistic regression analysis was: [Formula: see text]The best predictive equation according to stepwise multiple linear regression analysis was: [Formula: see text] (TS/PTP Gr = 1 if TS/PTP Gr 3 or 4, TS/PTP Gr = 0 if TS/PTP Gr 1 or 2).The predictive models for oropharyngeal surgery described in this study may be useful for planning surgical treatments and improving objective outcomes in adult OSA patients

The Effect of Body Position on Airway Patency in Obstructive Sleep Apnea: CT Imaging Analysis

PURPOSE: Positional change during sleep influences upper airway patency. However, few studies have used imaging techniques to demonstrate the change. This study aims to determine the effect of positional change on the upper airway space. METHODS: A total of 118 subjects with sleep breathing disorders were analyzed. Participants underwent upper airway CT scans in the supine and lateral decubitus positions (right and left). They were divided into non-obstructive sleep apnea (n = 28) and obstructive sleep apnea (n = 90) groups. We measured the minimal cross-sectional area of the retropalatal/retroglossal spaces and compared the differences of those two spaces in the supine and lateral positions. CT was performed while patients were awake. RESULTS: The minimal cross-sectional area in the OSA group was significantly smaller than non-OSA group in both supine (median[interquartile range], 8.3[0.0-25.1] vs 22.2[1.0-39.6]; P = 0.018) and lateral decubitus positions (5.2[0.0-16.9] vs 21.3[6.1-38.4]; P = 0.002). As the body position of OSA patients shifted from supine to lateral, the retroglossal space increased significantly (67.3[25.1-116.3] vs 93.3[43.4-160.1]; P \u3c 0.001). However, there was no significant difference in the retropalatal space between the supine and lateral decubitus positions. CONCLUSIONS: Positional change from the supine to lateral decubitus position expands the upper airway lumen, especially the retroglossal space. Positional OSA may be related to anatomical change of the upper airway lumen based on body position

Upper Airway Evaluation in Patients with Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a widespread disease of substantial social burden. As various surgical procedures are now developed to alter the offending anatomic abnormalities, identification of the exact problematic site with application of the most appropriate treatment including surgical procedure is essential for effective surgical treatment of OSA. To date, many techniques are available for the physician to assess and analyze the upper airway obstruction including radiographic cephalometry, sleep video fluoroscopy, computed tomography imaging, sleep magnetic resonance imaging, drug induced sleep endoscopy, multi-channel pressure measurements, acoustic reflectometry, and basic physical examinations. However there are still some controversies concerning the effectiveness and morbidity of each technique. Therefore, sleep medicine doctors should understand the characteristics of each tool with the pathophysiology of OSA. Herein, we review the clinical methods to evaluate the upper airway in terms of disease severity and treatment selection

Baseline data (N = 156).

<p>Baseline data (N = 156).</p