Heung Man Lee

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Isam Alobid, MD, PhD1, Nithin D. Adappa, MD2, Henry P. Barham, MD3, Thiago Bezerra, MD4, Nadieska Caballero, MD5, Eugene G. Chang, MD6, Gaurav Chawdhary, MD7, Philip Chen, MD8, John P. Dahl, MD, PhD9, Anthony Del Signore, MD10, Carrie Flanagan, MD11, Daniel N. Frank, PhD12, Kai Fruth, MD, PhD13, Anne Getz, MD14, Samuel Greig, MD15, Elisa A. Illing, MD16, David W. Jang, MD17, Yong Gi Jung, MD18, Sammy Khalili, MD, MSc19, Cristobal Langdon, MD20, Kent Lam, MD21, Stella Lee, MD22, Seth Lieberman, MD23, Patricia Loftus, MD24, Luis Macias‐Valle, MD25, R. Peter Manes, MD26, Jill Mazza, MD27, Leandra Mfuna, MD28, David Morrissey, MD29, Sue Jean Mun, MD30, Jonathan B. Overdevest, MD, PhD31, Jayant M. Pinto, MD32, Jain Ravi, MD33, Douglas Reh, MD34, Peta L. Sacks, MD35, Michael H. Saste, MD36, John Schneider, MD, MA37, Ahmad R. Sedaghat, MD, PhD38, Zachary M. Soler, MD39, Neville Teo, MD40, Kota Wada, MD41, Kevin Welch, MD42, Troy D. Woodard, MD43, Alan Workman44, Yi Chen Zhao, MD45, David Zopf, MD46

Epigenetic regulation of myofibroblast differentiation and extracellular matrix production in nasal polyp-derived fibroblasts.

Nasal polyposis is a multi‐factorial disease associated with chronic inflammatory condition of the paranasal sinuses. Myofibroblast differentiation and extracellular matrix (ECM) accumulation are involved in the pathogenesis of nasal polyposis.

Antimicrobial peptide LL-37 is upregulated in chronic nasal inflammatory disease

Objective--LL-37 is one of the antimicrobial peptides and the only member of the cathelicidin family identified so far in humans. We attempted to find a correlation between LL-37 peptide and inflammation of the nasal mucosa. Material and methods--Nasal mucosa specimens were obtained from 15 chronic infective rhinitis patients and 6 normal controls. Immunohistochemical staining was used to examine the localization of LL-37 and reverse transcriptase polymerase chain reaction (RT-PCR) was used to determine the levels of LL-37, IL-1β and IL-8 in tissue. Results--LL-37 peptide was primarily localized in the surface of the epithelia, in the serous and mucous cells of the submucosal glands and in stromal inflammatory cells. The number of LL-37 immunoreactive cells in inflammatory nasal mucosa was significantly increased compared with normal nasal tissue. Using RT-PCR, LL-37 mRNA was detected in 3/6 normal turbinate samples but in all cases with inflammatory nasal tissues. IL-1β and IL-8 transcripts exhibited a similar pattern to that of LL-37. Conclusions--We suggest that LL-37 is one of the antimicrobial peptides found in human nasal mucosa and that it participates in the innate immune system of the nasal mucosa.

Antimicrobial defensin peptides of the human nasal mucosa

Defensins, a prominent group of antimicrobial peptides, are an important component of the innate immune response, particularly at mucosal surfaces that are vulnerable to colonization by potential pathogens. The present study was undertaken to investigate the expression of defensins in inferior turbinate mucosa of normal subjects and inferior turbinate mucosa and nasal polyps of patients with chronic sinusitis. Expression of β-defensin 1 and 2 and α-defensin 5 and 6 messenger RNAs (mRNAs) was investigated by reverse transcriptase–polymerase chain reaction, and their expression level was semiquantitatively evaluated by dot blot hybridization. Immunohistochemical analysis was used for detection of α-defensins 1, 2, and 3 in tissue sections. β-Defensin 1 mRNA was expressed in all tissue samples, at levels that did not differ significantly. β-Defensin 2 mRNA was detected in the turbinate mucosa and nasal polyps of patients with chronic sinusitis, but not in normal mucosa. Its expression level was significantly higher in nasal polyps than in turbinate mucosa. α-Defensin 5 and 6 mRNAs were not expressed in any tissues, but α-defensins 1, 2, and 3 were detected in all tissue samples obtained from patients with chronic sinusitis. These results suggest that β-defensin 1 may play a constitutive role in nasal defenses, whereas α-defensins 1, 2, and 3 and β-defensin 2 may be induced in response to local infection or inflammation.

Volumetric study in the development of paranasal sinuses by CT imaging in Asian: A Pilot study

BACKGROUND AND OBJECTIVES The volume of the air cavities in the paranasal sinuses is not only the simplest, but also the most important index for paranasal sinus evaluation. However, few volumetric studies have been performed in all age groups. The purpose of the current study was to outline the normal development of paranasal sinuses in all age groups, and to determine normal adult volumetric values by means of computed tomographic (CT) scan of paranasal sinus using volumetric procedures. MATERIALS AND METHODS A prospective volumetric CT study was conducted with 260 patients (520 sides) <25 years of age by means of three-dimensional reconstruction. RESULTS The frontal sinuses began to pneumatize at 2 years of age, exhibited a faster growth pattern between 6 and 19 years of age, and the mean volume after full growth was 3.46±0.78 cm(3). The maxillary sinuses were pneumatized at birth in all cases, exhibited a monomodal growth pattern increasing until 15 years of age, and the mean volume after full growth was 14.83±1.36 cm(3). The floor of the sinus was the same level as the floor of the nasal cavity was between 7 and 15 years of age. The ethmoid sinuses exhibited a faster initial tendency to increase until 7 years of age, were completed by 15-16 years of age, and the mean volume after full growth was 4.51±0.92 cm(3). The sphenoid sinuses exhibited a growth spurt between 6 and 10 years of age, were completed by 15 years of age, and the mean volume after full growth was 3.47±0.93 cm(3). CONCLUSION The results of this study are presented to provide the basis for an objective normal volume of sinus development and for studies involving diseases of the sinuses.

Acute Pancreatitis Signals Activation of Apoptosis-Associated and Survival Genes in Mice

In experimental models of acute pancreatitis (AP), acinar cell death occurs by both necrosis and programmed cell death or apoptosis. Apoptosis is an active form of cell death associated with a tightly regulated expression of gene products that are either pro- or antiapoptotic. The aim of this study was to characterize pancreatic mRNA levels by Northern blotting analysis of apoptosis-associated genes used during the course of cerulein-induced AP in mice. Histone H3 mRNA levels were also examined as an indicator of cell proliferation. Acinar cell apoptosis was confirmed histologically. The findings show that AP modifies pancreatic mRNA levels of both pro- and antiapoptotic genes simultaneously. Pancreatic bclXL, bax, and p53 mRNA levels increased significantly in a temporal fashion during induction of AP. Pancreatic bcl-2 mRNA levels were unchanged during AP. Pancreatic mRNA levels of insulin-like growth factor-1 (IGF-1), a mitogen and cell survival factor, and its receptor (IGF-1R) also increased in a temporal fashion during induction of AP. In summary, this study indicates that acinar cell death during cerulein-induced AP in mice can occur by the apoptotic pathway. Since factors promoting and antagonistic for cell survival are activated simultaneously, regulation of acinar cell survival appears complex and dynamic during AP.

Dual ectopic thyroid.

Ectopic thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue in a site other than in its usual pre-tracheal region. It occurs along the path of descent of the developing thyroid primodium from the foramen cecum. It most commonly presents itself as a lingual thyroid and is the only thyroid in 70% of all cases. It is extremely rare for two ectopic foci of thyroid tissue to be present simultaneously. The authors report a recent case of dual ectopic thyroid present in the lingual and infrahyoid areas with no thyroid tissue in the pre-tracheal area in a 15-year-old girl. The patient had originally been scheduled for surgery under the impression of thyroglossal duct cyst; however, a pre-operative computed tomography scan of neck and thyroid scans revealed the presence of dual ectopic thyroid, thus preventing unnecessary surgery. Therefore, thyroid scan, along with either neck CT or neck ultrasonogram, should be performed routinely to avoid unnecessary surgery if the clinical picture is at all compatible with thyroid ectopia.

Endoscopic removal of an intranasal ectopic tooth

Intranasal ectopic teeth are rare and ectopic eruption of teeth can occur in a variety of locations. Commonly seen in the palate and maxillary sinus, they have also been reported in the mandibular condyle, coronoid process, orbital and nasal cavities, and through the skin. With the advent of sinonasal endoscopy in the mid 1980s, and subsequent advances in surgical techniques, endoscopic management of intranasal lesions has become possible. In the current case study, we report a successful endoscopic removal of intranasal ectopic teeth located in the nasal cavity. The endoscopic surgical approach used in this case caused less morbidity than do the more common methods of removing an intranasal ectopic tooth.

Validation study of portable device for the diagnosis of obstructive sleep apnea according to the new AASM scoring criteria: Watch-PAT 100

Abstract Conclusion: Watch-PAT may provide an accurate and clinically effective portable monitoring method for the diagnosis of obstructive sleep apnea (OSA). Objective: This study was designed to assess the accuracy and clinical efficacy of a wrist-worn portable device (Watch-PAT 100) to diagnose OSA. Methods: Twenty-seven participants with suspected OSA underwent full polysomnography (PSG). Finally, 25 subjects successfully underwent portable monitoring using Watch-PAT after full PSG. The study population consisted of 21 males and 4 females, mean age 40.9 ± 11.2 years (range 21–59). Mean body mass index (BMI) was 26.2 ± 2.6 kg/m2 (range 21.2–32.3). All PSG were manually scored according to the new scoring manual of the American Academy of Sleep Medicine (2007) and the Watch-PAT data were analyzed by the automatic algorithm. Results: There was a high correlation of apnea-hypopnea index (AHI) (r = 0.94, p < 0.001) and lowest oxygen saturation (LSAT) (r = 0.90, p < 0.001) between the PSG and the Watch-PAT. A good agreement was also found between PSG AHI, PSG LSAT and PAT AHI, PAT LSAT, respectively. There was a significantly high concordance of the severity of AHI (Kendall tau-b = 0.897, p < 0.001) between the PSG and the Watch-PAT.

How does open-mouth breathing influence upper airway anatomy?

Objectives/Hypothesis: Open‐mouth breathing during sleep may increase the severity of obstructive sleep apnea (OSA) and complicate nasal continuous positive airway pressure (CPAP) therapy in patients with OSA. The aim of this study was to assess the effect of open‐mouth breathing on upper airway anatomy using lateral cephalometry and fiberoptic nasopharyngoscopy.