Endotoxin is not essential for the development of cockroach induced allergic airway inflammation

PURPOSE: Cockroach (CR) is an important inhalant allergen and can induce allergic asthma. However, the mechanism by which CR induces airway allergic inflammation and the role of endotoxin in CR extract are not clearly understood in regards to the development of airway inflammation. In this study, we evaluated whether endotoxin is essential to the development of CR induced airway allergic inflammation in mice. MATERIALS AND METHODS: Airway allergic inflammation was induced by intranasal administration of either CR extract, CR with additional endotoxin, or endotoxin depleted CR extract, respectively, in BALB/c wild type mice. CR induced inflammation was also evaluated with toll like receptor-4 (TLR-4) mutant (C3H/HeJ) and wild type (C3H/HeN) mice. RESULTS: Intranasal administration of CR extracts significantly induced airway hyperresponsiveness (AHR), eosinophilic and neutrophilic airway inflammation, as well as goblet cell hyperplasia in a dose-dependent manner. The addition of endotoxin along with CR allergen attenuated eosinophilic inflammation, interleukin (IL)-13 level, and goblet cell hyperplasia of respiratory epithelium; however, it did not affect the development of AHR. Endotoxin depletion in CR extract did not attenuate eosinophilic inflammation and lymphocytosis in BAL fluid, AHR and IL-13 expression in the lungs compared to CR alone. The attenuation of AHR, eosinophilic inflammation, and goblet cell hyperplasia induced by CR extract alone was not different between TLR-4 mutant and the wild type mice. In addition, heat inactivated CR extract administration induced attenuated AHR and eosinophilic inflammation. CONCLUSION: Endotoxin in CR extracts may not be essential to the development of airway inflammation.ope

Exercise-induced airway obstruction in young asthmatics measured by impulse oscillometry

BACKGROUND: Impulse oscillometry (IOS) is a good method for measuring airway resistance. It does not require special breathing skills and it can reflect different aspects of airway obstruction to those revealed by spirometry, which is an effort-dependent maneuver. OBJECTIVE: To evaluate the characteristics of airway obstruction in young asthmatics after an exercise bronchial provocation test (EBPT) using IOS. METHODS: Forty-seven young adults were enrolled in the study. All the participants underwent a methacholine bronchial provocation test (MBPT) and an EBPT for the evaluation of their asthma. IOS and spirometric parameters were collected at baseline and at 0, 5, 10, 20, and 30 minutes post-EBPT.The participants were divided into 2 groups according to MBPT positivity: an airway hyperresponsiveness (AHR) group and a no-AHR group. RESULTS: There were differences in the percent decrease in forced expiratory volume in the first second (FEV1) between the 2 groups at 5, 10, and 20 minutes after exercise. Resistance at 5 Hz (R5) increased in the AHR group but not in the no-AHR group at 5 and 10 minutes after exercise. Integration of reactance from 5 Hz to resonance frequency (area of reactance, AX) was also increased in the AHR group at only 5 and 10 minutes post-EBPT. Delta R5 and delta AX at 5 and 10 minutes post-exercise were well correlated with the percent decrease in FEV1. CONCLUSIONS: IOS parameters, especially delta R5 and delta AX, may be useful for performing objective evaluations and improving our understanding of exercise-induced airway obstruction in young asthmatics.ope

Measurement Specific IgE against Recombinant 16-kD and 19-kD Buckwheat Allergens for the Diagnosis of Buckwheat Allergy

BACKGROUND: Buckwheat (BW, Fagopyrum esculentum)-specific IgE (sIgE) measurement is crucial to diagnose BW allergy. However, clinical application is difficult due to a high false-positive rate. Previously we identified 16-kD 2S storage albumin and 19-kD vicilin-like protein as BW major allergens. OBJECTIVE: To investigate clinical usefulness of sIgE measurements against recombinant 16- and 19-kD BW allergens compared to the skin prick test and measurement of specific IgE against whole buckwheat (WBW) extract. METHOD: Eleven BW allergic patients, 11 asymptomatic sensitizers to BW and 16 non-atopic subjects were enrolled. We performed the skin prick test, sIgE measurement against recombinant 16- and 19-kD BW allergens and WBW extract using a CAP system. RESULT: In BW allergic patients, sIgE against WBW extract, r16- and r19-kD BW allergens were detected in 10, 5 and 9 patients, respectively. In asymptomatic sensitizers, sIgE against WBW extract, r16- and r19-kD BW allergens were detected in 9, 1 and 2 patients respectively. In ROC analysis, the AUC value of sIgE level was higher in r19-kD allergen than in r16-kD or WBW extract. CONCLUSION: We suggest that CAP sIgE against r19-kD and r16-kD BW allergens can be a diagnostic marker to discriminate BW allergic patients from asymptomatic sensitizers in a clinical settingope

Surgical anatomy of middle turbinate

의학과/석사[한글]이비인후과 의사들은 수술 혹은 외래 진료 시, 매우 많은 중비갑개(middle turbinate)의 변이에 직면하곤 한다. 하지만 이전의 중비갑개에 관한 기술들은 단지 중비갑개의 크기나 모양에만 초점을 맞추었기 때문에, 부비동 내시경 수술(endoscopic sinus surgery)을 진행하는데 있어 충분한 해부학적인 정보를 제공하지 못하였다. 따라서 저자는 본 연구에서 정중앙으로 절단한 한국 성인 사체에서의 중비갑개의 수술적 해부를 관찰하여 기술함으로써, 진료 및 수술에 도움을 주고자 하였다. 101개의 표본에서 중비갑개에 관한 지표들을 눈금자(digital caliper) 및 각도기(protractor)를 이용하여 측정하였으며, 중비갑개를 크기와 형태에 따라 구분하였다. 중비갑개의 전방 부착부위부터 상비갑개의 전방 부착부위까지의 평균 거리는 18.5 mm 이였으며, 중비갑개가 하비갑개보다 더 후방으로 돌출되어 있는 경우가 40% 였고 26.3% 의 경우에서는 하비갑개가 중비갑개보다 후방으로 돌출되어 있었다. 마지막으로 중비갑개를 전방의 형태를 기준으로 세가지로 분류하였다. 제 1형은 중비갑개가 공통갑개(conchal plate)에 부착된 곳에서 바로 후하방으로 진행한 형태로서 45.3%에서 관찰되었다. 제 2형은 중비갑개가 공통갑개에 부착된 곳에서 직하방으로 진행하다가 방향이 후하방으로 바뀐 형태로서 44.2%에서 관찰되었다. 10.5%에서는 중비갑개가 전방으로 튀어나온 후 후하방으로 향하였으며, 이런 형태를 제 3형이라고 분류하였다. 이와 같은 연구가 부분 중비갑개 절제술(partial middle turbinectomy)을 시행하는 이비인후과 의사들에게 많은 도움을 줄 수 있을 것으로 생각한다. [영문]Clinicians have encountered many variations of the middle turbinate. Previous descriptions of the middle turbinate were only focused on its size and shape and lacked surgical implications associated with endoscopic sinus surgery. Therefore, the aim of this study was to examine the surgical anatomy of the middle turbinate in hemisected cadaveric heads. The middle turbinates from 101 hemisections of adult Korean cadaveric heads were measured using digital calipers and a protractor. The middle turbinates were then classified according to their shape. The mean distance between the anterior attachment of the middle turbinate and the anterior attachment of the superior turbinate was 18.5 mm. The posterior end of the middle turbinate extended more posteriorly than that of the inferior turbinate in 40% of cases, while in 26.3% of cases, the posterior end of the inferior turbinate extended more posteriorly than that of the middle turbinate. The middle turbinate was classified into three types according to the shape of its anterior border. In type 1, the anterior border of the middle turbinate ran directly posteroinferiorly from its attachment to the conchal plate, and was observed in 45.3% of cases. In type 2, the anterior border of the middle turbinate initially coursed inferiorly from the conchal plate and then turned in a posteroinferior direction. This type was observed in 44.2% of cases. Type 3 involved 10.5% of cases where the anterior border bulged anteriorly before it coursed posteroinferiorly. The information provided in this report should assist surgeons when performing partial middle turbinectomies.ope

류마티스 인자 유무에 따른 류마티스 관절염의 임상상의 차이

학위논문(의학석사)--아주대학교 대학원 :의학과,2003testMaste

신규 해양미생물 추출물, luminacin의 autophagic cell death 를 통한 두경부암 항암효과분석

의과대학/박사To determine whether Luminacin, a marine microbial extract from the marine Streptomyces species, has anti-tumor effects on head and neck squamous cell carcinoma (HNSCC) cell lines via autophagic cell death. The inhibition of cell survival and increased cell death was measured using cell viability, colony forming, and apoptosis assays. Migration and invasion abilities of head and cancer cells were evaluated using wound healing, scattering, and invasion assays. Changes in the signal pathway related to autophagic cell death were investigated. Drug toxicity of Luminacin was examined in in vitro the HaCaT cells and an in vivo zebrafish model. Luminacin showed potent cytotoxicity in HNSCC cells in cell viability, colony forming and FACS analysis. In vitro migration and invasion of HNSCC cells were attenuated by Luminacin treatment. Combined with Beclin-1 and LC3B, Luminacin induced autophagic cell death in head and neck cancer cells. In addition, in a zebrafish model used for toxicity testing, embryonic or neural toxicity was not resulted in by Luminacin treatment with a cytotoxic concentration for HNSCC cells. Taken together, these results demonstrate that Luminacin induces the inhibition of growth and cancer progression via autophagic cell death in HNSCC cell lines, indicating a possible alternative chemotherapeutic approach for the treatment of HNSCC.ope

Endoscopic removal of a cystic neck mass via an axillo-breast approach

ope

Necessity of level IV dissection in cN0 hypopharyngeal carcinoma

CONCLUSIONS: We suggest that contralateral level IV dissection is not necessary in patients with cN0 hypopharyngeal squamous cell carcinoma (HPSCC). OBJECTIVES: Elective treatment of neck nodes is very important in the management of cN0 HPSCC. A selective neck dissection neck level II to IV (SND II-IV) is widely accepted as an elective neck treatment of cN0 HPSCC. However, there has been a lot of effort to reduce the extent of surgery. Therefore, we investigated the incidence of level IV metastasis and regional recurrence in cN0 HPSCC. METHODS: We performed a retrospective review of 40 patients who underwent SND II-IV as an elective treatment for cN0 HPSCC from 1992 to 2010. RESULTS: In all, 30 bilateral and 10 unilateral SND II-IVs were performed in 40 patients. Of the 70 SND II-IV specimens, 15 specimens from 14 patients (21%) were revealed to have positive lymph node metastasis. Level IV was involved in 3 of 70 necks (4.2%), but no isolated or contralateral level IV metastasis was observed. Every case that had level IV metastasis also had positive nodes in level II or III. There was no case of postoperative chylous leakage and only one case of phrenic nerve palsy.ope

Robotically assisted selective neck dissection in parotid gland cancer

OBJECTIVES/HYPOTHESIS: Robot-assisted neck dissection (ND) in head and neck cancer patients has been demonstrated to be feasible. We hypothesized that surgery for parotid cancer could be achieved via a gasless modified facelift approach using the robotic system. We intended to evaluate the feasibility of robot-assisted selective ND (SND) via a modified facelift (MFL) approach in parotid gland cancer. STUDY DESIGN: Case series. METHODS: Primary tumor resection with robotic SND I-III via MFL was performed in five patients with parotid gland cancer. RESULTS: All cases of robot-assisted SND I-III combined with primary tumor resection were successfully conducted without any significant intraoperative complication, applying additional incision or conversion to open conventional ND. The amount and duration of drainage, hospital stay, retrieved lymph nodes, and complications were generally acceptable. The postoperative scar was able to be completely hidden by the auricle and hair. CONCLUSIONS: Robotically assisted surgery via an MFL approach is a feasible and useful method, with excellent cosmetic results for the surgical treatment in selected cases of parotid gland cancer.ope

Radiotherapy deteriorates postoperative functional outcome after partial glossectomy with free flap reconstruction

PURPOSE: Most patients with tongue cancer require surgical resection of the tongue to varying degrees. As a result, quality of life, which is strongly related to speech, chewing, and swallowing, can deteriorate severely from extensive surgical treatment of tongue cancer. In addition to surgery, adjuvant therapy may affect the severity of functional impairment. Therefore, the influence of postoperative radiotherapy on functional outcome after partial glossectomy with free flap reconstruction was evaluated in patients with early oral tongue cancer. PATIENTS AND METHODS: Functional outcome was measured and charts of 31 patients with oral tongue cancer who were surgically treated at Yonsei Head and Neck Cancer Clinic from 2003 through 2008 were reviewed. Only patients who underwent partial glossectomy and reconstruction with radial forearm free flap and did not develop recurrence were included. Speech integrity was evaluated with diadochokinetic testing by a professional speech therapist. Tongue mobility was checked by measurements of upward distance, protrusion distance, and lateral deviation distance. Swallowing capacity was evaluated with the M.D. Anderson Dysphagia Inventory. RESULTS: Diadochokinetic rates of the surgery-only and postoperative radiotherapy groups were 27.8 and 23.9, respectively, which was statistically different. Swallowing capacity was significantly superior in the surgery-only group. Tongue mobility was not statistically different between the 2 groups. CONCLUSIONS: Functional outcome of speech and swallowing is negatively influenced by postoperative radiotherapy.ope