Hyun Jin Min

Expression of CAIII and Hsp70 Is Increased the Mucous Membrane of the Posterior Commissure in Laryngopharyngeal Reflux Disease

Purpose We tried to evaluate the difference in the expression of carbonic anhydrase (CA) III and heat shock protein (Hsp) 70 between laryngopharyngeal reflux disease (LPRD) and non-LPRD patients. Materials and Methods The study involved 28 patients who underwent laryngeal microsurgery due to benign laryngeal disease from March to August 2008. Reflux symptom index (RSI) and reflux finding score (RFS) were measured for each person, and they were assigned either to the LPRD group (n=10) or non-LPRD group (n=18). Tissue samples were obtained from the mucosa of posterior commissure, and immunohistochemistry (IHC) staining of CAIII and Hsp70 was performed. The IHC scores were measured and compared with clinical features including RSI and RFS. Results Total 10 patients were assigned as LPRD group, and 18 patients were as control group. The mean IHC score of CAIII and Hsp70 was 1.70±1.06 and 1.90±0.88, respectively, in LPRD patients, whereas the mean IHC score of CAIII and Hsp70 was 0.78±0.73 and 0.94±0.87, respectively, in non-LPRD patients. The difference between two groups was statistically significant (p<0.05). Conclusion CAIII and Hsp70 expressions were higher in LPRD patients that in non-LPRD patients, suggesting the possibility as one of biomomarker in LPRD diagnosis.

Tongue Volume Influences Lowest Oxygen Saturation but Not Apnea-Hypopnea Index in Obstructive Sleep Apnea

Objectives The aim of this study was to identify correlations between sleep apnea severity and tongue volume or posterior airway space measured via three-dimensional reconstruction of volumetric computerized tomography (CT) images in patients with obstructive sleep apnea (OSA) for use in predicting OSA severity and in surgical treatment. We also assessed associations between tongue volume and Mallampati score. Methods Snoring/OSA male patients (n = 64) who underwent polysomnography, cephalometry, and CT scans were enrolled in this retrospective study. OSA was diagnosed when the apnea-hypopnea index (AHI) was greater than 5 (mild 5–14; moderate 15–29; severe>30). The patients were also categorized into the normal-mild group (n = 22) and the moderate-severe group (n = 42). Using volumetric CT images with the three-dimensional reconstruction technique, the volume of the tongue, posterior airway space volume, and intra-mandibular space were measured. The volumes, polysomnographic parameters, and physical examination findings were compared, and independent factors that are related to OSA were analysed. Results No associations between tongue volume or posterior airway space and the AHI were observed. However, multivariate linear analyses showed that tongue volume had significantly negative association with lowest O2 saturation (r = 0.365, p = 0.027). High BMI was related to an increase in tongue volume. Modified Mallampati scores showed borderline significant positive correlations with absolute tongue volume (r = 0.251, p = 0.046) and standardized tongue volume (absolute tongue volume / intramandibular area; r = 0.266, p = 0.034). Between the normal-mild and moderate-severe groups, absolute tongue volumes were not different, although the standardized tongue volume in the moderate-severe group was significantly higher. Conclusion Absolute tongue volume showed stronger associations with lowest O2 saturation during sleep than with the severity of AHI. We also found that high BMI was a relevant factor for an increase in absolute tongue volume and modified Mallampati grading was a useful physical examination to predict tongue size.

T-helper 2 cytokine-induced heat shock protein 70 secretion and its potential association with allergic rhinitis: Hsp70 in pathogenesis of AR

Various inflammatory mediators have been found to be involved in the pathogenesis of allergic disease (AR). The role of heat shock proteins in AR has not been studied. The aim of this study was to investigate the levels of heat shock protein 70 (Hsp70) in the nasal lavage fluids of AR patients and controls to elucidate the role of Hsp70 in the pathogenesis of AR.

Modulation of heat shock protein 90 affects TGF-β-induced collagen synthesis in human dermal fibroblast cells.

Heat shock protein 90 is a chaperone molecule that aids in proper folding of target proteins. Recently, heat shock protein 90 was found to play a role in would healing through regulation of fibroblast functions. The aim of the present study was to investigate the role of heat shock protein 90 in collagen synthesis in human dermal fibroblasts. The effects of transforming growth factor-β, 17-N-allylamino-17-demethoxygeldanamycin, and transfection of heat shock protein 90 were evaluated by real-time PCR, western blot, and immunofluorescence assays. The Smad 2/3 and Akt pathways were evaluated to identify the signaling pathways involved in collagen synthesis. Heat shock protein 90 and collagen levels were compared in keloid and control tissues by immunohistochemical analysis. The expression of collagen was significantly increased after treatment with transforming growth factor-β, while 17-N-allylamino-17-demethoxygeldanamycin inhibited transforming growth factor-β-induced collagen synthesis. Overexpression of heat shock protein 90 itself with or without transforming growth factor-β increased collagen synthesis. These effects were dependent on Smad 2/3 pathway signaling. Finally, expression of heat shock protein 90 was increased in keloid tissue compared with control tissues. Taken together, these results demonstrate that modulation of heat shock protein 90 influences transforming growth factor-β-induced collagen synthesis via regulation of Smad 2/3 phosphorylation.

External radiopaque marking of Gillies posterior zygomatic arch osteotomy in reduction malarplasty

Although the Gillies (temporal) approach to reduction malarplasty helps preserve supportive soft tissue and avoid facial scars, the osteotomy site is difficult to gauge when using this blind technique. Our experience with external radiopaque marking of the zygomatic arch to guide this process is presented herein. This retrospective review included all patients who underwent reduction malarplasty (as above) at our clinic between August 2013 and September 2015. Procedures entailed L-shaped osteotomy only (no segmental excision) of the zygomatic body by the intraoral route, and posterior zygomatic arch osteotomy by the Gillies approach, guided by external radiopaque markings. Patient characteristics, surgical outcomes, and complications were analyzed to assess the merits of this strategy. Postoperative results were evaluated by both the patients and the surgeon. Most patients expressed satisfaction during the follow-up period (range, 3-27 months). Posterior osteotomies were properly performed as planned, with no major complications (i.e., malunion or nonunion, cheek drooping, or facial nerve injury), although minor complications were recorded in three instances. Use of external radiopaque markings provides guidance during malarplasty by the Gillies approach and may help avoid procedural complications.

Comment on: Excessive daytime sleepiness in chronic migraine and chronic tension-type headache from the general population

To the editor: We have read the articles ‘‘Excessive daytime sleepiness in chronic migraine and chronic tension-type headache from the general population’’ by Kristoffersen ES, et al. (1), published online first in Cephalalgia, with great interest. The authors performed a cross-sectional survey of 30,000 people aged 30–44 (323 eligible participants with chronic headache) to investigate the association between headache, especially chronic migraine (CM) or chronic tension-type headache (CTTH) and excessive daytime sleepiness (EDS). The authors concluded increased EDS was associated with higher headache frequency, but not with specific headache diagnoses. There is the major strength that this study is a large population-based sample which was representative of the general population by the high response rate. However, we would like to make three comments about this study for the benefit of the readers. First, authors described the participants’ information on socio-demographics, height, weight, smoking status, medication overuse, headache frequency and headache disability. However, they did not mention other conditions and diseases that can cause EDS such as snoring and obstructive sleep apnea (OSA). EDS is one of the most common symptoms in patients with snoring and OSA. OSA is by far the most common sleep disturbance of the general population, with an estimated prevalence of 2% and 7% in the adult population (2). Although there has been much controversy about the correlation between subjective EDS and objective polysomnographic findings, we think authors should consider whether the participants snore or have OSA, or not. Second, although headache may cause sleep disturbances including EDS, headaches may be inversely caused by OSA. So, we think that the relationship between headache and OSA should be considered. Headache prevalence due to OSA is estimated at 1–2% of the general population and affects 2–8% of the middle-aged population (3). On the other hand, there is no relation either between OSA and migraine or between OSA and TTH in the general population (4). Although there is still controversy, we suggest considerations should be given to the study of sleep disturbance in headache patients, since there is an association between headache and OSA. Third, the Epworth sleepiness scale (ESS) is a widely-used tool that subjectively measures EDS. It is a simple, self-administered questionnaire with an eightitem, four-point scale that investigates the possibility of a person falling asleep during various daily activities. However, we think there is a common methodological problem in previously reported studies, as follows. Most studies have used a cutoff of 10 points on the ESS score, dichotomizing patients into those with and without EDS. In this context, investigators had to accept the assumption that patients with an ESS score of 11 had the same degree of EDS as those who had an ESS score of 24. In addition, studies might classify patients with an ESS score of either 10 or 11 to either the non-EDS or EDS groups, despite the difference in subjective score being one point out of the 24-point scale between these two groups of patients. So, it is recommended that clinicians be cautious when using ESS for the diagnosis of obstructive sleep apnea and determining the response to treatment. We suggest using more objective tools to measure EDS, such as the multiple sleep latency test (MSLT), may be useful in your further study. Fong et al. demonstrated that MSLT was better than ESS in the assessment of EDS in patients with OSA (5).

Proprotein convertase inhibition promotes ciliated cell differentiation – a potential mechanism for the inhibition of Notch1 signalling by decanoyl-RVKR-chloromethylketone

Chronic repetitive rounds of injury and repair in the airway lead to airway remodelling, including ciliated cell loss and mucous cell hyperplasia. Airway remodelling is mediated by many growth and differentiation factors including Notch1, which are proteolytically processed by proprotein convertases (PCs). The present study evaluated a novel approach for controlling basal cell‐type determination based on the inhibition of PCs. It was found that decanoyl‐RVKR‐chloromethylketone (CMK), a PC inhibitor, promotes ciliated cell differentiation and has no effect on the ciliary beat frequency in air–liquid interface (ALI) cultures of human nasal epithelial cells (HNECs). Comparative microarray analysis revealed that CMK considerably increases ciliogenesis‐related gene expression. Use of cell‐permeable and cell‐impermeable PC inhibitors suggests that intracellular PCs regulate basal cell‐type determination in ALI culture. Furthermore, CMK effect on ciliated cell differentiation was reversed by a Notch inhibitor N‐[N‐(3,5‐difluorophenacetyl)‐l‐alanyl]‐S‐phenylglycine t‐butyl ester (DAPT). CMK inhibited the processing of Notch1, a key regulator of basal cell differentiation toward secretory cell lineages in the airway epithelium, and down‐regulated the expression of Notch1 target genes together with furin, a PC. Specific lentiviral shRNA‐mediated knockdown of furin resulted in reduced Notch1 processing and increased numbers of ciliated cells in HNECs. Moreover, CMK inhibited Notch1 processing and promoted regeneration and ciliogenesis of the mouse nasal respiratory epithelium after ZnSO4 injury. These observations suggest that PC inhibition promotes airway ciliated cell differentiation, possibly through suppression of furin‐mediated Notch1 processing.

Refractory sleep apnea caused by tubal tonsillar hypertrophy

Snoring/sleep apnea are usual symptoms of adenotonsillar hypertrophy, and adenotonsillectomy is usually recommended. In rare cases, symptoms remain after surgery, and tubal tonsil hypertrophy could be the cause. We experienced a pediatric patient whose symptoms were refratory snoring/sleep apnea although he previously underwent three times of adenotonsillectomy. We diagnosed tubal tonsil hypertrophy which was the cause of refractory symptoms, and decided to perform volume reduction with radiofrequency ablation. We suggest that tubal tonsil hypertrophy should be taken into account of the cause of refractory sleep apnea after adenotonsillectomy, and volume reduction with radiofrequency may be an effective method.

Infraorbital Neuralgia Attributed to a Foreign Body.

We reported a case of secondary infraorbital neuralgia due to a foreign body involving the nasal ala. As it was a very rare care, we reviewed reported literatures. This case highlights that infraorbital neuralgia could be caused by any tiny problems such as foreign body involving the area innervated by infraorbital nerve.

The correlation of serum eosinophil cationic protein level with eosinophil count, and total IgE level in Korean adult allergic rhinitis patients

Background: Eosinophil cationic protein (ECP) is present in eosinophil granules. It has been associated withxa0eosinophil-associated disorders. Objective: We compared serum ECP levels in allergic and non-allergic rhinitis patients and evaluated the association with the eosinophil count and the total IgE level. Method: We retrospectively reviewed medical records and categorized enrolled patients into the allergic (AR) andxa0non-allergic rhinitis (NAR) groups. ECP, eosinophil count, and total IgE levels were reviewed in both groups. Thexa0association between ECP and the eosinophil count and total IgE level was further evaluated according to commonlyxa0detected specific antigens. Results: Six hundred and ten adults were included in the study. In the AR group (n=349), the median age was 27.0xa0(23.0-42.0) years and the female:male ratio was 0.26:1. In the NAR group (n=261), the median age was 32.0(24.0-45.5) years and the female:male ratio was 0.33:1. We found that ECP (AR: 18.8(9.9-31.4), NAR: 14.8(8.2-24.9), p=0.003), eosinophil count (AR: 191.0(112.0-308.5), NAR: 149.0(91.0-249.0), p=0.002) and total IgE (AR: 166.0(58.4-422.5), NAR: 68.8(24.5-141.0), p<0.001) were higher in AR than in NAR patients. The ECP level was associated with the eosinophil count in both the AR (p<0.001) and NAR groups (p<0.001). A significant correlation between the ECP level and eosinophil count was demonstrated in AR patients who were skin test positive against house dust mite, animal and pollen allergens. Conclusions: We suggest that ECP could be an important mediator in the pathogenesis of AR. The level of serum ECP was positively correlated with eosinophilia in AR patients regardless of the type of allergen sensitization. However, further study is warranted to verify the role of ECP in the clinical management of allergic rhinitis. Key words: eosinophil cationic protein, immunoglobulin E, eosinophil count, allergic rhinitis, MAST DOIxa010.12932/AP0739