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Nasal hemangiomas most commonly occur in the anterior part of the nose, including the Little's area of the nasal septum, the anterior tip of the inferior nasal turbinate, and the vestibule. They rarely develop in the posterior part of the inferior nasal turbinate and meatus. Here, we report a case of cavernous hemangioma at the posterior aspect of the left inferior meatus in a 79-year-old man who presented with epistaxis and progressive nasal obstruction for 4 months after blowing his nose forcefully and review the relevant literature. An endoscopic evaluation revealed a dark red mass in the posterior part of the left inferior meatus that did not extend to the posterior choana or nasopharynx. The tumor was removed with endoscopic surgery under general anesthesia. No recurrence was observed during a 2-year follow-up. Our experience suggests that forceful nose blowing is a traumatic stimulus that can lead to hemangiomas arising in the posterior nasal cavity in rare instances., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Allergen immunotherapy is regarded as the only disease-modifying treatment option for various allergic conditions, including allergic rhinitis and asthma. Among the routes of administration of allergens, sublingual immunotherapy (SLIT) has gained clinical interest recently, and the prescription of SLIT is increasing among patients with allergies. After 30 years of SLIT use, numerous pieces of evidence supporting its efficacy, safety, and mechanism allows SLIT to be considered as an alternative option to subcutaneous immunotherapy. Based on the progressive development of SLIT, the current guideline from the Korean Academy of Asthma, Allergy, and Clinical Immunology aims to provide an expert opinion by allergy, pediatrics, and otorhinolaryngology specialists with an extensive literature review. This guideline addresses the use of SLIT, including 1) mechanisms of action, 2) appropriate patient selection for SLIT, 3) the currently available SLIT products in Korea, and 4) updated information on its efficacy and safety. This guideline will facilitate a better understanding of practical considerations for SLIT., Competing Interests: There are no financial or other issues that might lead to conflict of interest., (Copyright © 2024 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease.)

Objectives: Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years., Methods: A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention., Results: Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m 2 ), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR ( P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR., Conclusions: General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient's urological history and urinary conditions appear to affect the occurrence of POUR., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Actinomycosis is common in the head and neck region but rarely occurs in the nasal septum. A 75-year-old male patient with an edentulous maxilla, hypertension, and diabetes developed actinomycosis confined to the nasal septum and showed mucosal necrosis and septal bony sequestration. The patient underwent surgery and medication therapy; this case was reported using endoscopic photographs and radiographs and a literature review was conducted to provide further context and understanding of the condition of the patient., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Allergen immunotherapy (AIT) is a causative treatment for various allergic diseases such as allergic rhinitis, allergic asthma, and bee venom allergy that induces tolerance to offending allergens. The need for uniform practice guidelines in AIT is continuously growing because of the increasing discovery of potential candidates for AIT and evolving interest in new therapeutic approaches. This guideline is an updated version of the Korean Academy of Asthma Allergy and Clinical Immunology recommendations for AIT published in 2010. This updated guideline proposes an expert opinion by allergy, pediatrics, and otorhinolaryngology specialists with an extensive literature review. The guideline deals with basic knowledge and methodological aspects of AIT, including mechanisms, clinical efficacy, patient selection, allergens extract selection, schedule and doses, management of adverse reactions, efficacy measurements, and special consideration in pediatrics. The guidelines for sublingual immunotherapy will be covered in detail in a separate article., Competing Interests: There are no financial or other issues that might lead to conflict of interest., (Copyright © 2023 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease.)

Lipomas are the most common soft tissue lesions occurring in the salivary glands but have a very low incidence. Lipomas commonly occur in the parotid gland, and lipomas in the submandibular gland (SMG) are rare. Until recently, ordinary lipomas of the parotid gland and some variants of lipomas of the SMG have been reported. However, few reports of ordinary lipomas occurring within the SMG exist in the literature. We report an extremely rare case of ordinary lipoma within the right SMG of a 65-year-old man. The tumor measured a 2.0 × 1.8 × 2.7 cm, was a well-capsulated homogenous yellow mass, which was composed of mature adipose tissue. A partially mixed area with salivary gland tissue was observed. There has not been much research on lipomatous tumors from the SMG because of their rareness. Most lipomatous tumors in the parotid gland are known as ordinary lipomas, but more research is needed to determine whether they can be applied to the SMG. Thus, this report will be instrumental in the understanding of lipomatous tumors of the SMG.

In the era of novel coronavirus epidemics, vaccines against coronavirus disease 2019 (COVID-19) have been recognized as the most effective public health interventions to control the pandemic. An adverse event following immunization (AEFI) is defined as any untoward occurrence following immunization, and the majority of AEFIs are caused by protective immune responses stimulated by vaccines. Most of the reported AEFIs are not serious, and many are not immunologically mediated or even reproducible on re-exposure. However, uncommon severe allergic adverse reactions, such as anaphylaxis or other allergic reactions, can occur after vaccinations. Confirmed allergic reactions to vaccines may be caused by residual non-human protein, preservatives, or stabilizers in the vaccine formulation (also known as excipients). There are 2 main potential allergenic/immunogenic excipients in COVID-19 vaccines, polyethylene glycol (PEG) and polysorbate 80. PEG, also known as macrogol, is an ingredient in various laxatives and injectable formulations, such as depot steroids. Polysorbate 80 is present in various medical products, creams, ointments, lotions, and medication tablets. Contraindications to the administration of COVID-19 vaccines include a previous history of severe allergic reactions to the first dose of COVID-19 vaccine or proven hypersensitivity to a vaccine component, such as PEG or polysorbate 80. Anaphylaxis or other allergic reactions following immunization can cause fear and loss of confidence in the safety of vaccines among the public. A better understanding of these events is thought to help alleviate concerns about the current COVID-19 vaccines and provide reassurance to the general population by analyzing the exact incidence of anaphylaxis and potential risk factors. COVID-19 vaccine-associated anaphylaxis could be prevented and managed by risk stratification based on our local and global experience., Competing Interests: There are no financial or other issues that might lead to conflict of interest., (Copyright © 2021 The Korean Academy of Asthma, Allergy and Clinical Immunology · The Korean Academy of Pediatric Allergy and Respiratory Disease.)

Purpose: The purpose of this study is to examine the characteristics of resistance among medical students toward e-portfolios and find the strategies for them to successfully prepare e-portfolios., Methods: Participants were a group of 258 medical students. The questionnaire comprised 13 items developed based on the innovation resistance theory. The data were analyzed using descriptive analysis and Spearman's correlation analysis using PASW SPSS version 18.0 (SPSS Inc., Chicago, USA)., Results: Students perceived that e-portfolios have a high degree of relative advantage, trialability, and complexity as their innovation resistance characteristics. Regarding perceived risk, they did not want others to see their information, but they had a high degree of demand for communication with their professors., Conclusion: The successful use of portfolios can serve as a tool for student management and assessment that can reflect their introspection, personal development, and academic performance. This study proposed the strategies to promote the use of e-portfolios by strengthening education on the need for them, specific feedback of instructors, and students' autonomy.

Background: Because severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) rarely occur, clinical data based on large-scale studies are still lacking., Objective: To provide information on culprit drugs and clinical characteristics, including morbidity and mortality of SCARs based on a nationwide registry., Methods: SCAR cases that occurred from 2010 to 2015 were recruited to the Korean SCAR registry from 34 tertiary referral hospitals. Demographics, causative drugs, causality, and clinical outcomes were collected by reviewing the medical record., Results: A total of 745 SCAR cases (384 SJS/TEN cases and 361 DRESS cases) due to 149 drugs were registered. The main causative drugs were allopurinol (14.0%), carbamazepine (9.5%), vancomycin (4.7%), and antituberculous agents (6.3%). A strong preference for SJS/TEN was observed in carbonic anhydrase inhibitors (100%), nonsteroidal anti-inflammatory drugs (84%), and acetaminophen (83%), whereas dapsone (100%), antituberculous agents (81%), and glycopeptide antibacterials (78%) were more likely to cause DRESS. The mortality rate was 6.6% (SJS/TEN 8.9% and DRESS 4.2%). The median time to death was 19 days and 29 days in SJS/TEN and DRESS respectively, and 89.8% of deaths occurred within 60 days after the onset of the skin symptoms., Conclusion: Allopurinol, carbamazepine, vancomycin, and antituberculous agents were the leading causes of SCARs in Korea. Some drugs preferentially caused a specific phenotype. The mortality rate of SCARs was 6.6%, and most of the deaths occurred within 2 months., (Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: The human leukocyte antigen (HLA)-B*13:01 was reported as an important risk factor for dapsone hypersensitivity syndrome (DHS) in Chinese and Thai populations., Research Design and Methods: From the Korean nationwide registry, seven subjects with previous DHS were included. Their HLA allele/phenotype frequencies were compared with 8 dapsone-tolerant subjects recruited from a single institution, and general population (n = 485) in Korea. The authors also performed a meta-analysis with these data using previous Chinese and Thai studies., Results: Among the seven DHS subjects, 85.7% presented with the HLA-B*13:01 allele. The HLA-C*03:04, HLA-DRB1*12:02 (both in linkage disequilibrium with HLA-B*13:01), and HLA-A*02:01 alleles were also presented in 85.7%, 71.4%, and 71.4%, respectively. Subjects with HLA-B*13:01 were susceptible to developing DHS compared to dapsone-tolerant controls (odds ratio [OR]: 73.667) and the Korean general population (OR: 139.500). HLA-C*03:04 (OR: 40.935), HLA-DRB*12:02 (OR: 36.613), and HLA-A*02:01 (OR: 5.862) showed similar results. In meta-analysis, HLA-B*13:01 was associated with dapsone-induced hypersensitivity (overall OR: 42.692), and subgroup analyses according to the control types demonstrated similar results (OR:43.694 and 41.866, respectively)., Conclusions: Similar to previous Asian population studies, HLA-B*13:01 is significantly associated with the risk of DHS in Korea. These associations may be useful for preventing DHS and improving drug safety.

Rationale: Stylohyoid complex syndrome is characterized by various cervicopharyngeal symptoms related to the ossification and abnormality of the styloid process, stylohyoid ligament, and the lesser horn of the hyoid bone. Eagle syndrome is the most well-known of the spectra of these diseases. Although surgical treatment is considered effective, conservative treatment may be beneficial if symptoms arise because of inflammation of the soft tissues attached to the styloid process or hyoid bone., Patient Concerns: A 68-year-old man presented with pain in the right side of the neck and odynophagia after trauma on his philtrum. He was diagnosed with Eagle syndrome elicited by a fracture from indirect trauma. Despite analgesic medication and physiotherapy, the pain had somewhat relieved but persisted for 1 year., Diagnosis: Computed tomography revealed complete ossification of the bilateral stylohyoid complex. A fracture was observed in the ampulla on the right side of the neck. One year later, the fracture resolved by complete union., Interventions: Ultrasonography was performed and abnormal ossification was observed on the right side of the neck. Five milligrams of dexamethasone at a concentration of 1 kg/m was slowly injected into the tender point under ultrasonographic guidance., Outcomes: The patient reported immediate reduction of pain and was satisfied with the resolution. No recurrence was observed during a 6-month follow-up period., Lessons: Although traumatic fracture of the ossified ligament elicited the syndrome, the results were satisfactory because the origin of the patient's pain was presumed to arise from inflammatory conditions. This case demonstrates that treatment with local steroid injection may be appropriate for patients who present with pain originating from muscles and ligaments.

Purpose: Vomeral malformation may lead to a posteroinferior septal defect (PISD). It is usually found incidentally, without any characteristic symptoms. The purpose of this study was to evaluate its clinical implications., Methods: In this study, we included 18 patients with PISD after reviewing paranasal sinus computed tomography scans and medical records of 2655 patients. We evaluated the shape of the hard palate and measured the distances between the anterior nasal spine (A), the posterior end of the hard palate (P), the posterior point of the vomer fused with the palate (V), the lowest margin of the vomer at P (H), and the apex of the V-notch (N)., Results: None of the PISD patients had a normal posterior nasal spine (PNS). Six patients lacked a PNS or had a mild depression (type 1 palate), and 12 had a V-notch (type 2 palate). The mean A-P, P-H, and P-V distances were 44.5 mm, 15.3 mm, and 12.4 mm, respectively. The average P-N distance in patients with type 2 palate was 7.3 mm. There were no statistically significant differences between the types of palates in A-P, P-H, or P-V distances. In patients with type 2 palate, there was a significant correlation between P-V and P-N distances (r = 0.664, p = 0.019)., Conclusions: PISD due to vomeral malformations was identified in 0.7% of the cases in this study. None of the subjects had a normal PNS, which suggests that the development of the vomer is closely related to that of the hard palate.

The improvement of sleep quality in patients with cancer has a positive therapeutic effect on them. However, there are no specific treatment guidelines for treating sleep disturbance in cancer patients. We investigated the effect of forest therapy on the quality of sleep in patients with cancer. This study was conducted on nine patients (one male, eight female; mean age, 53.6 ± 5.8 years) with gastrointestinal tract cancer. All patients participated in forest therapy for six days. They underwent polysomnography (PSG) and answered questionnaires on sleep apnea (STOP BANG), subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI), sleepiness (Stanford and Epworth Sleepiness Scales), and anxiety and depression (Hospital Anxiety and Depression Scale) to evaluate the quality of sleep before and after forest therapy. Sleep efficiency from the PSG results was shown to have increased from 79.6 ± 6.8% before forest therapy to 88.8 ± 4.9% after forest therapy ( p = 0.027) in those patients, and total sleep time was also increased, from 367.2 ± 33.4 min to 398 ± 33.8 min ( p = 0.020). There was no significant difference in the STOP BANG score, PSQI scores, daytime sleepiness based on the results of the Stanford and Epworth Sleepiness Scales, and depression and anxiety scores. Based on the results of this study, we suggest that forest therapy may be helpful in improving sleep quality in patients with gastrointestinal cancers.

Spontaneous temporomandibular joint (TMJ) herniation is the entity of protrusion of the retrodiscal contents of the TMJ into the external auditory canal (EAC) through a persistent Huschke's foramen. There have been a number of reports of spontaneous TMJ herniation, but there are no reports of bilateral symptomatic TMJ herniation. We report a case of a 70-year-old man who complained of a crunching sound in both ears during mastication. Examination showed bulging from the anterosuperior wall of the EAC on each side when the patient opened his mouth, which pushed the tympanic membrane medially. Bony defects in the corresponding area were seen on computed tomography. We describe a very rare case of bilateral spontaneous TMJ herniation that caused symptoms by having a direct impact on the tympanic membrane., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Introduction: Antrochoanal polyps (ACPs) have several unique features that distinguish them from other nasal polyps. Despite many investigations, the pathogenesis of ACP has not yet been elucidated. Sinonasal osteoma is the most common type of tumor of the sinonasal tract and can be caused by trauma, infection and developmental anomaly., Presentation of Case: We report the case of a 35-year-old man with left nasal obstruction for more than 20 years. Examination revealed ACP concomitant with an osteoma that arose from the middle turbinate and ethmoid sinus. The osteoma had an air cell in its anterosuperior area and was in a position of being pulled downward. The intranasal part of the ACP covered the posterior area of the osteoma., Discussion: Considering the radiological and surgical findings, the intranasal part of the ACP seems to have affected the turbinoethmoidal osteoma during its growth., Conclusion: The authors describe a very rare condition in which an ACP was connected with a turbinoethmoidal osteoma., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Hereditary angioedema (HAE) is a genetically heterogeneous autosomal dominant disorder characterized by recurrent episodes of nonpruritic, nonpitting edema increasing after puberty. It can be fatal due to laryngeal or gastrointestinal (GI) involvement with varied and changing frequency of mortality according to studies published from the Western countries. Epidemiological and clinical data of HAE in Asian countries are sparse. We sought to examine the clinical characteristics of HAE patients in Korea., Methods: Patients diagnosed with HAE at 15 tertiary hospitals across the country until 2016 were retrospectively reviewed., Results: A total of 65 patients diagnosed with HAE by 2016 were identified. The prevalence of HAE was estimated at 1.3/1,000,000 in Korea. Of the 65 patients, 21 (32.3%) were males. A total of 90.8% patients had type I HAE, while the remaining 9.2% patients had type II HAE. The first symptom developed after 20 years in 73.8% of patients, with a mean age 28.4 ± 14.1 years. The age at diagnosis was 36.5 ± 15.8 years, with a mean time delay of 7.8 ± 10.5 years. While the face (82.3%) and extremities (upper 71.0%, lower 62.9%) were the most frequently involved, the GI tract was affected in 40.5% of Korean HAE patients. Prophylaxis was maintained in 62.5% of patients. There was no reported case of death from HAE so far., Conclusions: The clinical manifestation and severity of HAE may vary according to ethnicity. HAE is more infrequent and GI involvement is less likely in Korea compared with Western countries., (© 2018 S. Karger AG, Basel.)

Background: The present study aimed to investigate the mental health status in patients with asthma and assess the effects of asthma on suicidal ideation and attempts using a representative sample from Korea., Methods: Individual-level data were obtained from 228,744 participants (6372 with asthma and 222,372 without asthma) of the 2013 Korean Community Health Survey. Demographic characteristics, socioeconomic status, physical health status, and mental health status were compared between patients with asthma and population without asthma. Multivariable logistic regression was performed to investigate the independent effects of the asthma on suicidal ideation and attempts., Results: A depressed mood for 2 or more continuous weeks was reported by 12.0% of subjects with asthma and 5.7% of controls ( p  < 0.001). Suicidal thoughts were reported by 21.4% of patients with asthma and 9.8% of controls ( p  < 0.001). Suicidal attempts were reported by 1.0% of the patients with asthma and 0.4% of controls ( p  < 0.001). Following adjustment for age, sex, income, education, job, marital status, smoking, alcohol, exercise, and presence of diabetes mellitus, hypertension, stroke, arthritis, and depression, the ORs for suicidal ideation with asthma were 1.53 (95% CI 1.42-1.65) and that for suicidal attempts was 1.32 (95% CI 1.01-1.73)., Conclusions: We found that asthma increased the risk for suicidal ideation and attempts, even controlling for the effects of socioeconomic status, physical health status, comorbid chronic medical diseases, and depressive mood. Our finding suggests that asthma per se may be an independent risk factor for suicidality.

This study examined lexical processing in English by native speakers of Korean and Chinese, compared to that of native speakers of English, using normal, alternated, and inverse fonts. Sixty four adult students participated in a lexical decision task. The findings demonstrated similarities and differences in accuracy and latency among the three L1 groups. The participants, regardless of L1, had a greater advantage in nonwords than words for the normal fonts because they were able to efficiently detect the illegal letter strings. However, word advantages were observed in the visually distorted stimuli (i.e., alternated and inverse fonts). These results were explained from the perspectives of the theory of psycholinguistic grain size, L1-L2 distance, and the mechanism of familiarity discrimination. The native speakers of Chinese were more sensitive to visual distortions than the Korean counterpart, suggesting that the linguistic template established in L1 might play a role in word processing in English.

Purpose: The higher prevalence of respiratory allergic disease may be due to increased exposure to inhalation allergens. We conducted a survey of allergic diseases in autumn and winter with detection of major indoor allergens in major cities in Korea., Methods: We enrolled 110 subjects from the fourth Korea National Health and Nutrition Examination Survey with stratified, cluster, and systematic sampling procedures. All participants answered a health questionnaire as well as underwent a skin prick test (SPT) and ImmunoCAP for 11 indoor major allergens. We also measured the levels of 5 major allergens (Der f 1, Der p 1, Can f 1, Bla g 1, and Asp f 1) in fine indoor dust from the houses of 60 subjects with a 2-site ELISA., Results: The prevalence of allergic rhinitis and asthma were 25.5% and 7.3%, respectively. The most common sensitized allergens identified by SPT and ImmunoCAP were Dermatophagoides farinae (40.9%, 36.8%), followed by cockroach (23.6%, 19.5%), mugwort (13.6%, 22.9%), oak (9.1%, 22.9%), Japanese hop (9.1%, 8.6%), and dog dander (8.2%, 6.9%). There was a modest discrepancy between SPT and ImmunoCAP. Der f 1 and Der p 1 were detected in 91.7% and 45.0% of the enrolled houses, respectively. Der f 1 indicated high concentrations in all specific provinces in Korea; however, Der p 1 measured high only in the south. Dog dander allergens were present in 71.7% of houses; however, Bla g 1 was present in only 11.7% of houses and Asp f 1 was not detected in any houses., Conclusions: The most important inhalant allergens in Korea are house dust mites followed by cockroach, mugwort, oak, Japanese hop, and dog dander in indoor environment, in which The dominant species of house dust mites were different according to region.

This study investigated the tendency of overpassivization of unaccusative verbs by Korean learners of English as a foreign language (FL). Sixty Korean native college students participated in the study, along with 17 English-speaking counterparts serving as a comparison group. Consistent with the findings of previous research, this study found Korean students' tendency to incorrectly accept passive-voice with inanimate subjects. The results of this study highlighted the role of lexical animacy, the hierarchy of agentivity, and language-specific effects on FL judgment. The findings of this study suggest a robust language-specific L1 effect on L2 acquisition and a greater involvement of cognition in FL use than language input.

We present a promising electrolyte candidate, Mg(TFSI)2 dissolved in glyme/diglyme, for future design of advanced magnesium (Mg) batteries. This electrolyte shows high anodic stability on an aluminum current collector and allows Mg stripping at the Mg electrode and Mg deposition on the stainless steel or the copper electrode. It is clearly shown that nondendritic and agglomerated Mg secondary particles composed of ca. 50 nm primary particles alleviating safety concern are formed in glyme/diglyme with 0.3 M Mg(TFSI)2 at a high rate of 1C. Moreover, a Mg(TFSI)2-based electrolyte presents the compatibility toward a Chevrel phase Mo6S8, a radical polymer charged up to a high voltage of 3.4 V versus Mg/Mg(2+) and a carbon-sulfur composite as cathodes.

Purpose: Pharmacovigilance Research Network built a spontaneous reporting system and collected adverse drug reactions (ADRs) by electronic submission (e-sub) in Korea. We analyzed ADRs spontaneously reported through e-sub from regional health professionals., Materials and Methods: Nine hundred and thirty three ADR cases were collected and analyzed from January to December in 2008. "A matter" was defined as one symptom matched to one culprit drug included in an ADR case. We collected and analyzed e-sub ADR cases and matters to determine common culprits and organ specified ADR matters., Results: There were 3,049 matters in 933 ADR cases for 1 year, and 3.3 matters per case were reported. In organ specific ADR classification, skin reactions which took the first place in 866 matters (28%) included urticaria and rash. The next cases were neurologic symptom (624 matters, 21%) and gastrointestinal symptom (581 matters, 19%). Doctor (53%) and pharmacist (31%) were the most important participants in e-sub spontaneous reporting system, and 3% of ADR cases were reported by patients or their guardians. WHO-Uppsala Monitoring Center causality assessment results showed certain 10.6%, probable 37.7%, possible 41.7% and below unlikely 10.0%. Culprit drugs were antibiotics (23.4%), neurologic agents (14.7%) and non-steroidal anti-inflammatory drugs (9.4%)., Conclusion: In our study, antibiotic was most common culprit drug, and skin manifestation was most common symptom in e-sub ADRs collected from regional healthcare practitioners in Korea.

Objectives: The quality of life (QoL) in systemic lupus erythematosus (SLE) patients may be affected by psychological features and disease status. We evaluated the QoL of SLE patients according to four subscales of QoL compared to healthy controls, and the association with affecting factors., Methods: 108 patients with SLE and 52 healthy controls completed a psychological questionnaire. Depression, fatigue, and QoL were assessed with the Centre for Epidemiologic Studies Depression Scale, the Profile of Mood States Fatigue-Inertia Scale, and Functional Assessment Chronic Illness Therapy. Disease activity and damage index were measured by the SLE Disease Activity Index and SLE Collaborating Clinics/American College of Rheumatology., Results: SLE patients showed higher degrees of depression (p=0.005) and a lower total QoL score than the controls (p=0.003). In the subscale analysis, physical well-being (PWB) and emotional well-being (EWB) were lower in the SLE group than the control group (p<0.001 for both). Multivariate analysis identified correlations between the following factors: total QoL with depression and daily glucocorticoid dose; PWB with depression, fatigue, and daily glucocorticoid; EWB with depression and functional well-being (FWB) with depression., Conclusions: The QoL of SLE patients was lower than that of healthy controls. QoL subscales of the SLE patients were associated with daily glucocorticoid dose, depression, and fatigue rather than disease activity or damage. Comprehensive evaluation of psychological problems and appropriate management may improve the QoL of SLE patients, especially those using higher doses of glucocorticoids, even if disease activity and damage are not severe.

The clinical success of non-viral gene delivery reagents is hampered by their inefficient cellular transgene delivery, which is largely influenced by carrier properties that are currently undefined and misunderstood. In an attempt to further define and understand the requirements for a safe and efficient non-viral gene delivery reagent, research labs often engineer and evaluate many putative products with subtle physiochemical differences in order to delineate requirements for improved in vitro and in vivo success. The synthesis of many putative reagents is often time-intensive, laborious and costly. In a previous manuscript published by our lab, different amounts of poly(triethylenetetramine/cystamine bisacrylamide) (p(TETA/CBA) and its pegylated counterpart, poly(triethylenetetramine/cystamine bisacrylamide)- poly(ethylene glycol) (p(TETA/CBA)-g-PEG) were mixed together to easily identify optimal reagent properties and candidates in vitro, while avoiding the synthesis of many putative candidates for study. This report uses the aforementioned facile approach to evaluate reagent properties of products that were obtained via one-pot synthesis, which improved synthetic ease. As such, synthesis time was reduced from 6days to 3days and had comparable or improved transfection and viability compared to previous works. Moreover, this synthesis resulted in higher molecular weight products than were used in the previous study and allow for lower polymer doses to be used for complexation, which is useful for systemic delivery that is used herein. The physiochemical properties of the formulations derived using these novel reagents was studied prior to investigating their in vivo biodistribution profiles in a murine colon adenocarcinoma model. Interestingly, negatively charged complexes exhibited greater passive tumor accumulation compared to positively charged complexes following their systemic administration. These studies warrant further investigation for the use of negatively charged drug and gene delivery reagents for passive tumor targeting, and they substantiate the use of polycation/PEG-polycation mixtures for facile product evaluation in order to elucidate design and formulation mandates for the clinical success of non-viral gene delivery formulations., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: The prevalence of asthma is increasing, and asthma causes considerable socioeconomic burden worldwide. Few studies have been conducted to evaluate the risk factors associated with economic cost of asthma in Korea. This study evaluated asthma cost according to severity, control, and patient factors in Korean tertiary hospitals., Methods: Direct and indirect costs were assessed in physician-diagnosed adult asthmatics recruited from eight tertiary hospitals in Korea. Official direct medical costs were derived from the analysis of 1-year expenditures related to hospital care utilization and asthma medication. Nonofficial medical costs, nonmedical direct costs, and indirect costs were investigated using a questionnaire designed specifically for the study., Results: A total of 314 patients with persistent asthma were recruited. Both direct and indirect costs were significantly higher for patients with severe persistent asthma than for those with mild and moderate persistent asthma ($2214 vs. $871 and $978, p < .001; $2927 vs. $490 and $443, p < .001, respectively). Costs of asthma increased significantly in poorly controlled compared with somewhat controlled and well-controlled asthma ($7009.8 vs. $2725.3 vs. $1517.3, respectively; p < .001). After stratification for severity, a significant cost increase in the poorly controlled asthma group was observed only for indirect costs and not for direct costs. A multivariate analysis showed that female gender was a risk factor for increased indirect costs., Conclusion: The burden of asthma was higher both for patients with severe persistent asthma and for patients with poorly controlled asthma. More effective strategies are needed to improve control status, particularly targeting patients with severe asthma.

Aim: Thromboxane A synthase (TBXAS1) converts prostaglandin H to thromboxane A, a potent constrictor of smooth respiratory muscle. Thus, functional alterations of the TBXAS1 gene may contribute to aspirin-intolerant asthma (AIA)., Materials & Methods: We investigated the relationship between SNPs in the TBXAS1 gene and AIA. Asthmatics (n = 470) were categorized into AIA (20% or greater decreases in forced expiratory volume in 1 s [FEV(1)], or 15% to 19% decreases in FEV(1) with naso-ocular or cutaneous reactions) and aspirin-tolerant asthma (ATA). A total of 101 SNPs were genotyped. mRNA expression of the TBXAS1 gene by peripheral blood mononuclear cells and plasma thromboxane B2 (TXB2) concentrations were measured by reverse transcriptase (RT)-PCR and ELISA., Results: Logistic regression analysis showed that the rare allele frequency of rs6962291 in intron 9 was significantly lower in the AIA group (n = 115) than in the ATA group (n = 270) (p(corr) = 0.04). The linear regression analysis revealed a strong association of rs6962291 with the aspirin challenge-induced FEV(1) fall (p = 0.003). RT-PCR revealed an exon-12-deleted splice variant. We measured TBXAS1 mRNA levels in peripheral blood mononuclear cells. The mRNA levels of the full-length wild-type and splice variant were significantly higher in the TT homozygotes than in the AA homozygotes of rs6962291 (1.00 ± 0.18 vs 0.57 ± 0.03 and 1.00 ± 0.18 vs 0.21 ± 0.05, p = 0.047 and 0.001, respectively). The plasma TXB2 level was significantly lower in rs6962291 AA carriers than in rs6962291 TT (p = 0.016) carriers., Conclusion: The rare allele of rs6962291 may play a protective role against aspirin hypersensitivity via a lower catalytic activity of the TBXAS1 gene, attributed to the increase of a nonfunctioning isoform of TBXAS1.

Purpose: To evaluate the prevalence, compliance, pattern of use, and economic cost of OM in Korean allergy patients., Methods: A total of 647 allergy patients were enrolled from 10 general hospitals, and were surveyed by the questionnaire. It consisted of 12 items and regarded the prescription rates, reasons for referring, their opinions for the efficacy of OM, and economic costs., Results: A total of 259 (40.5%) patients had used OM, and 35.5% of these patients experienced two or more kinds of these practices. A patients' income or education level did not affect the prescription rates of OM. Of the patients that used OM, 34.6% of them were satisfied with the effect of OM treatment, and 40.9% of them were inclined to continue with their OM treatments. The most frequent reasons for choosing OM were the patient's belief that OM can predispose 'allergic constitution to normal' (30.2%), worries about the possible adverse reactions of the long-term administration of the proven drugs (20.2%), and the safety of OM (15.6%). However, 18.9% of these patients experienced perceived adverse events to their OM treatment such as skin rashes, gastrointestinal discomfort, and hepatitis. The patients that have used OM spent on average $915 US dollars annually for OM treatment., Conclusions: Many Korean allergy patients are cliental to OM. Some patients experienced a satisfactory treatment effect from OM, however, others had no treatment effect, even adverse event. Therefore, it is important to educate people to use OM appropriately to make harmony with modern medicine., (Copyright © 2010 John Wiley & Sons, Ltd.)

Aspirin-intolerant asthma (AIA) is an asthma phenotype characterized by the development of bronchoconstriction following ingestion of aspirin. Despite the well-defined pathological trigger, the underlying mechanisms of AIA are still unclear. With the biophysical characteristics of the human EMI domain-containing protein 2 (EMID2) gene in relation to the extracellular matrix deposition and epithelial-mesenchymal transition as pivotal characteristics of airway remodeling in asthma, we hypothesized that genetic polymorphisms of EMID2 might affect the development of AIA. In this study, the allelic associations of 49 single-nucleotide polymorphisms (SNPs) of the human EMID2 gene were evaluated from 163 AIA patients and 429 aspirin-tolerant asthma (ATA) subjects as controls in a Korean population. Logistic analysis showed that five SNPs (P = 0.01-0.04, but P (corr) > 0.05) and EMID2&#95;BL2&#95;ht2 haplotype (unique to the minor alleles of rs4727494 and rs13233066; P = 0.02; P (corr) = 0.02) were significantly associated with AIA. More interestingly, regression analysis of the decline of forced expiratory volume in one second (FEV(1)) by aspirin provocation revealed that 10 SNPs (P = 0.003-0.04) and four relevant haplotypes (P = 0.002-0.02) were significantly associated with the fall rate of FEV(1) by aspirin provocation, indicating that genetic polymorphisms of EMID2 could cause meaningful deficits in the upper and lower airways among AIA patients. These findings provide evidence that EMID2 may be a susceptible genetic factor for aspirin hypersensitivity among asthmatics in Korean population.

Objective: Aspirin affects interleukin-4 (IL-4) synthesis; however, the genetic role of IL-4 has not been evaluated in asthmatics with aspirin hypersensitivity. The objective of the study was to examine the influence of single nucleotide polymorphisms (SNPs) in IL-4 gene on aspirin hypersensitivity in asthmatics at the genetic and molecular levels., Methods: Aspirin-intolerant (AIA, n=103) and aspirin-tolerant asthmatics (n=270) were genotyped and functional promoter assays were performed., Results: Of 15 SNPs tested, seven (-589T>C (rs2243250) in promoter, -33T>C (rs2070874) in the 5'-untranslated region, +4047A>G (rs2243266), +4144C>G (rs2243267), +4221C>A (rs2243268), +4367G>A (rs2243270), and +5090A>G (rs2243274) in introns) were significantly associated with AIA risk. The frequency of the rare allele (C) of -589T>C was higher in the AIA group than in the aspirin-tolerant asthmatic group (P=0.016), and a gene dose-dependent decline in forced expiratory volume in 1 s was noted after an aspirin challenge (P=0.0009). Aspirin unregulated IL-4 mRNA production in Jurkat T and K562 leukemia cells. A reporter plasmid assay revealed that aspirin augmented IL-4 promoter transactivation with the -589T>C C and -33T>C C alleles, compared with that bearing the -589T>C T and -33T>C T alleles. Further, electrophoretic mobility shift assay showed the formation of nuclear complexes with -33T>C and -589T>C allele-containing probes; this was augmented by aspirin. The complexes formed with the -33T>C and -589T>C probes were shifted by treatment with anti-CCAAT-enhancer-binding proteins β and anti-nuclear factor of activated T-cells antibodies, respectively, indicating the inclusion of these transcription factors., Conclusion: Aspirin may regulate IL4 expression in an allele-specific manner by altering the availability of transcription factors to the key regulatory elements in the IL4 promoter, leading to aspirin hypersensitivity.

Purpose: The effects of air cleaners on the removal of airborne indoor allergens, especially house dust mites (HDM), are still controversial. The objective of this study is to evaluate the effect of an air cleaner with an electrostatic filter on the removal of airborne mite allergens., Materials and Methods: A dried HDM culture medium that contained mite body particles and excretions was dispersed in a chamber equipped with an electrostatic air cleaner. The number of airborne particles was recorded continuously by a dust spectrometer for 60 minutes. Airborne particles in the chamber were collected on a sampling filter at a flow rate of 10 L/min and the Der f 1 concentration in the filter extracts was measured by two-site ELISA., Results: The air cleaner efficiently removed airborne HDM particles. The air cleaner removed airborne HDM particles (size 2-12.5 µm) 11.4 ± 2.9 fold (cleaner operating for 15 minutes), 5.4 ± 0.7 fold (cleaner operating for 30 minutes), and 2.4 ± 0.2 fold (cleaner operating for 60 minutes) more than the removal of HDM particles by natural settle down. Removal kinetics differed according to the particle size of the airborne particles. The air cleaner decreased the concentration of Der f 1 in the extraction of airborne particles collected on the air sampling filter by 60.3%., Conclusion: The electrostatic air cleaner can remove airborne HDM allergens and may be useful as a supplementary environmental control tool for HDM sensitized respiratory allergic patients.

Aspirin-intolerant asthma (AIA) is characterized by severe asthmatic attack after ingestion of aspirin and/or non-steroidal anti-inflammatory drugs. In this study, we investigated the relationship between Prostaglandin E2 receptor (PTGER) gene family polymorphisms and AIA in 243 AIA patients and 919 aspirin-tolerant asthma (ATA) controls of Korean ethnicity in two separate study cohorts. After genotyping 120 SNPs of the PTGER gene family for the 1(st) cohort study, four SNPs in PTGER1, ten in PTGER3, six in PTGER3, and a haplotype of PTGER2 showed association signals with decreased or increased risk of AIA. Among the positively associated SNPs, one in PTGER1 and four in PTGER3 were analyzed in the 2(nd) cohort study. The results show that rs7543182 and rs959 in PTGER3 retained their effect, although no statistical significance was retained in the 2(nd) cohort study. Our findings provide further evidence that polymorphisms in PTGER3 might play a significant role in aspirin hypersensitivity among Korean asthmatics.

Purpose: Patterns of prescriptions are markedly influenced by regional disease entities, medical education, culture, economic status, and available pharmaceutical companies. Features of adverse drug reactions (ADRs) may vary in different countries. In this study, we analyzed the causative drugs and clinical manifestations of spontaneously reported ADRs in Korea., Methods: Six Korean Regional Pharmacovigilance Centers collected 1418 cases of spontaneously reported adverse drug events (ADEs) by doctors, pharmacists, and nurses, and the clinical features and causative drugs were evaluated. The data were collected from general hospitals (76.5%), primary clinics, and pharmacies (23.5%)., Results: Based upon the World Health Organization (WHO)-Uppsala Monitoring Center criteria (certain-13.7%, probable-46.1%, possible-32.1%), 91.9% of the collected events were suspected to be ADRs and 15.8% of patients experienced serious ADRs. The most prevalent causative drugs were antibiotics (31.6%), followed by contrast dyes (14.0%), non-steroidal anti-inflammatory drugs (NSAIDs) (11.1%), anti-psychotics (5.4%), anti-convulsants (5.2%), cardiovascular agents (4.8%), anti-neoplastics (4.6%), and opiates and non-opiate pain killers (3.5%). Among the antibiotics, cephalosporins (8.1%) were the most common, followed by anti-tuberculosis agents (5.7%), quinolones (4.0%), vancomycin (3.1%), and penicillin (2.8%). The most common side effect was skin manifestations, which were seen in 42% of the patients, followed by neurologic manifestations (14%), gastrointestinal involvements (12.9%), generalized reactions (9.4%), and respiratory involvements (4.5%)., Conclusion: Antibiotics, contrast dyes, and NSAIDs were the most common causative drugs for ADRs, which reflects the prescription pattern and the prevalence of diseases in Korea. These data may be useful in establishing a Korean pharmacovigilance system., (2009 John Wiley & Sons, Ltd.)

Background: Intermethod comparison between IMMULITE 2000 chemiluminescent enzyme immunoassay (CLEIA) and the established CAP test for allergen-specific IgE (sIgE) has only been evaluated by a few studies., Methods: We performed such an interassay comparison using 283 Korean allergic patients with the following: asthma (18.4%), allergic rhinitis (18.4%), both asthma and allergic rhinitis (14.5%), atopic dermatitis (21.9%), and others (26.8%). We compared the sIgE detection performance of both systems for 10 major inhalant allergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blattela germanica, cat dander, dog hair, alder, birch, oak, ragweed, and mugwort) and four food allergens (egg white, cow milk, peanut, and shrimp)., Results: After 645 paired comparison tests, close association and significant correlation were observed between the results of both assays for most of these allergens (r=0.525-0.979, p<0.05, respectively), except for shrimp. Intermethod agreement based on sIgE detection was fair to good (74.1-100%, kappa=0.514-1.000, p<0.05, respectively) for most allergens except for B. germanica, ragweed, and shrimp. Although both assays showed good accuracy in ROC curve analysis, some minor differences were noted., Conclusions: IMMULITE 2000 CLEIA for sIgE detection showed fair to good intermethod correlation, association, agreement, and accuracy in comparison to the established CAP assay among Korean allergic patients. However, we should take into account the intermethod differences between both assays for clinical applications.

We developed a new method to covalently attach well-defined polymers onto carbon nanotubes (CNTs) using a radical reaction. Well-defined poly(t-butyl acrylate) [p(tBA)] was first prepared by atom transfer radical polymerization, which formed radicals at the end of the polymer chain through an atom transfer. The generated radicals at the chain ends added CNTs to generate covalently functionalized p(tBA)-grafted CNTs. The polymer-attached CNTs showed much improved solubility in organic solvents. The synthesized MWNT-g-p(tBA) and SWNT-g-p(tBA) were characterized by IR, TGA and Raman spectroscopy, clearly indicating the formation of covalent bonding between p(tBA) and CNTs.

Background: Mechanical laundry is an effective tool for the environmental control of allergens, but the optimal conditions for removing allergens are not yet clear., Objective: To evaluate the optimal conditions of mechanical laundry for the removal of house dust mite (HDM), dog dander, and pollen allergens., Methods: The 4 washing modes of 30 degrees C (86 degrees F), 40 degrees C (104 degrees F), 60 degrees C (140 degrees F), and steam water (SW) with detergent were evaluated. Allergen removal performance was assayed using a 2-site enzyme-linked immunosorbent assay (ELISA) or an ELISA inhibition test., Results: Using the 30 degrees C and 40 degrees C washing modes, only 6.5% and 9.6% of Dermatophagoides farinae, respectively, were killed. However, using the 60 degrees C and SW washing modes, all HDMs were killed. The amounts of Der f 1 remaining after the 30 degrees C, 40 degrees C, 60 degrees C, and SW washing modes were 26.8%, 2.4%, 1.3%, and 0.6%, respectively, with unmanipulated contaminated sheets. The effects of rinse on Der f 1 levels after the 30 degrees C washing were greater compared with those after the 40 degrees C, 60 degrees C, and SW modes. The amounts of Can f 1 in the extractions after washing were 0.3% to 1.3% for all modes, and all extracts, even without a rinse, did not inhibit specific IgE binding to dog allergens according to ELISA. The remaining pollen allergen levels after washing were lower in the 60 degrees C and SW modes than in the lower temperature modes. However, the levels did not differ among the various washing modes after rinsing once., Conclusion: Water temperature and number of rinses are critical factors for the removal of HDM, dog dander, and pollen allergens.

Background: Chrysanthemum, dandelion, and mugwort belong to the Compositae (Asteraceae) family. Their cross-allergenicity has not yet been completely evaluated., Objective: To investigate the sensitization and cross-allergenicity of these 3 plants., Methods: We reviewed 6,497 respiratory allergic patients who underwent skin prick tests (SPTs) during the last 10 years (1995-2005) and analyzed the sensitization rates of the 3 pollens. We sorted this population by wheal size and selected the monosensitized or cosensitized patients. Their serum samples were used to evaluate specific IgE (sIgE) and cross-allergenicity of the 3 pollens by CAP, immunoblotting, and inhibition enzyme-linked immunosorbent assay (ELISA)., Results: On SPTs, mugwort, chrysanthemum, and dandelion sensitized 13.4%, 10.0%, and 8.5% of the enrolled population, respectively, and 5.2% of the population was cosensitized to all 3 pollens. Some patients were monosensitized to 1 species (1.5% to chrysanthemum, 1.4% to dandelion, and 4.5% to mugwort). In inhibition ELISA that used a pooled serum sample cosensitized to all 3 pollens, mugwort inhibited sIgE bindings to chrysanthemum, dandelion, and mugwort up to 95%, 86%, and 96%, respectively. The 50% inhibitory allergen concentrations for sIgE to each of the 3 species were not different between solid-phase antigen and mugwort. The mugwort sIgE of this pooled serum was suppressed up to 74% and 27% by chrysanthemum and dandelion, respectively. The 50% inhibitory allergen concentrations of chrysanthemum and dandelion for mugwort sIgE were 0.3 and 57.0 microg/mL, respectively, whereas that of mugwort was 0.05 microg/mL. We found a patient who was truly monosensitized to dandelion., Conclusion: Chrysanthemum and dandelion were frequently cosensitized with mugwort in the general population with respiratory allergic diseases. These 2 species also showed extensive cross-allergenicity with mugwort. True monosensitization to these 2 species was possible.

Background: The 16-kDa protein of buckwheat (BW) has been implicated as a major allergen in BW allergy., Objective: To characterize the 16-kDa allergen and evaluate its clinical significance as an indicator of BW allergy., Methods: Complementary DNA from the 16-kDa allergen was cloned and expressed in Escherichia coli. Allergenicity was confirmed with IgE immunoblotting or with an enzyme-linked immunosorbent assay. The clinical utility of the recombinant protein (r16 kDa) for diagnosis of BW reactivity was evaluated in 18 BW-allergic and in 20 asymptomatic BW-sensitized subjects., Results: The 16-kDa allergen, composed of 127 amino acids, has 50% homology to the reported 8-kDa BW allergen, which belongs to the 2 S storage albumin. The r16-kDa protein can inhibit specific IgE (sIgE) antibody binding to the native BW 16-kDa allergen but minimally inhibited sIgE binding to crude BW extract. Approximately 77.8% of patients with the BW allergy produced sIgE antibodies to the r16-kDa protein, compared with a complete lack of reactivity in the 20 asymptomatic BW-sensitized subjects. The areas of the receiver operating characteristic curves for the skin prick test (mean, 0.93; 95% confidence interval, 0.85 to approximately 1.01; P < .001) and the rl6-kDa enzyme-linked immunosorbent assay (mean, 0.93; 95% confidence interval, 0.84 to approximately 1.01; P < .001) were higher than the area of the BW IgE measurement curve determined by ImmunoCAP (a system for assaying serum IgE) (mean, 0.80; 95% confidence interval, 0.66 to approximately 0.94; P = .002)., Conclusions: The 16-kDa allergen belongs to the 2 S storage albumin. Measurement of rl6-kDa sIgE was more discriminating than measurement of ImmunoCAP sIgE in whole BW extracts for the diagnosis of clinical reactivity to BW.

Background: Clinical validity of impulse oscillometry (IOS) for the evaluation of airway obstruction and bronchodilation is a controversial issue in adults with asthma., Methods: This study enrolled 195 outpatients from October 1998 to October 2004. We performed IOS in 158 asthmatic adults, including 70 asthmatic adults with a forced expiratory volume in 1 second (FEV,) reversibility (group 1), 88 asthmatic adults with hyperresponsiveness to methacholine or sputum eosinophilia (group 2) who did not meet the FEV, criteria, and 37 nonasthmatic adults (group 3)., Results: Baseline respiratory resistance at 5 Hz (R5), respiratory resistance at 10 Hz, frequency dependency of resistance (R5 to 2)), and resonance frequency were discriminative between asthmatic patients and nonasthmatic patients. The IOS parameters were decreased after bronchodilation in both asthmatic groups compared with the nonasthmatic group. Among these patients, R5 and R5 to 21 were the most discriminative parameters for evaluation of bronchodilation. Approximately one third of the patients with positive methacholine challenge test results or sputum eosinophilia manifested bronchodilation evaluated by these IOS parameters. Overall sensitivities of these parameters were comparable to FEV, for diagnosis of bronchodilation in 158 asthmatic adults. Logistic regression analysis showed that R5 to 20 was the most reliable parameter for prediction of R5 reversibility for all asthmatic adults., Conclusions: IOS may complement the estimation of obstruction and bronchodilation for asthmatic adults. Its discriminative power for airway obstruction and sensitivities for bronchodilation were comparable to FEV,.

Background: The 19-kD protein of buckwheat (BW) has been suggested to be a major allergen, but its characteristics and clinical significance are poorly defined., Methods: cDNA of the 19-kD BW allergen was cloned and expressed in Escherichia coli. Allergenicity and cross-allergenicity were confirmed by inhibition immunoblotting or by ELISA inhibition. The recombinant (r19-kD) protein was assessed for clinical utility in the diagnosis of BW reactivity in 18 BW-allergic and 19 BW-asymptomatic sensitized subjects using receiver operating characteristic analysis., Results: The 19-kD BW allergen, which is composed of 135 amino acids, has a weak homology to the vicilin-like allergens of cashew (Ana o 1), English walnut (Jug r 2) and 7 S globulin from Sesamum indicum. The r19-kD protein can inhibit sIgE binding to native 19-kD BW allergen. The maximum percentage inhibition of sIgE binding to crude BW extract was 56%. About 83.3% of the BW allergy patients had sIgE bound to r19-kD protein, compared to only 1 of the 19 BW-asymptomatic sensitized subjects. The areas under the receiver operating characteristic curves for the skin prick tests [0.925 (95% confidence interval: 0.839-1.012), p < 0.001] as well as r19-kD protein sIgE ELISAs [0.860 (95% confidence interval: 0.725-0.995), p <0.001] were higher than that of BW sIgE coated allergen particle test results [0.803 (95% confidence interval: 0.661-0.945), p = 0.002]., Conclusions: The 19-kD BW allergen may be the major allergen from BW. For the diagnosis of clinical reactivity to BW, the r19-kD protein sIgE ELISA test was more discriminative than the coated allergen particle sIgE measurement using whole BW extract., (Copyright 2007 S. Karger AG, Basel.)

Objectives: It is difficult to develop models of subglottic stenosis in small animals that ensure reliable stenosis. We therefore sought to establish a new animal model of subglottic stenosis in rabbits and observe subglottic wound healing., Methods: Using a diode laser under endoscopic visualization after anterior tracheal incision, we induced full-thickness injury to the subglottis in 60 rabbits: 20 on the anterior 120 degrees, 20 on the posterior 120 degrees, and 20 circumferentially. The animals were painlessly sacrificed 2 or 4 weeks later, and their gross and histologic findings were compared with those of each other and with those of 16 age-matched nonwounded controls., Results: Of the 60 animals, 22 died, primarily of acute airway obstruction and mostly in the circumferential group. All of the injured rabbits showed subglottic stenosis compared with controls, ranging from 12% to 56% reduction in cross-sectional area in the 120 degrees injured groups and from 32% to 82% reduction in the 360 degrees injured group. The significant narrowing of the subglottic lumina resulted in substantial early mortality in the circumferential group. Histologic examination showed mucosal ulceration, inflammation, and formation of granulation tissues during the acute phase after wounding, and collapse of the injured cartilage and submucosal thickening and fibrosis at later times., Conclusions: Subglottic healing and stenosis depend on the extent of cartilaginous injury. This model may be useful for developing methods to treat subglottic stenosis.

Background and Aims: Gastroesophageal reflux disease is related to various laryngeal sequelae. However, there is a lack of established reflux animal models covering longer observation periods. We evaluated the effects of acid, pepsin, and bile acid on healing of the traumatized subglottis in a simulated reflux model., Methods: In the first experiment, 48 rabbits were inflicted with a posterior subglottic injury using a diode laser, and there were 10 unwounded controls. After catheter insertion under transoral endoscopic guidance, animals were randomly assigned to one of the four groups: acid reflux (pepsin 0.3 mg/mL+taurodeoxycholic acid 0.155 mg/mL+acid pH 2); nonacid reflux (pepsin+taurodeoxycholic acid+pH 6); saline reflux; and unwounded control. Animals received catheter irrigation with 3 mL of a mixed solution or saline, twice daily for 6 wk. In the second experiment, 36 animals were inflicted with a subglottic injury followed by acid or saline reflux treatment and were sacrificed after 1, 2, and 4 wk for time-serial observations. Gross and histological findings were compared among the different groups., Results: Catheter-related problems were minor. Most animals received laryngopharyngeal irrigation with the solutions well, and 19 were excluded. Inflammation scores, fibrosis, thickening, and luminal stenosis were greatest in the acid reflux group (p<0.005). Values were not different between the nonacid reflux and saline reflux groups (p>0.1)., Conclusions: Our data suggest that subglottic wound healing is significantly affected by pepsin and bile acid only under acidic conditions. This implies that acid-suppressive therapy can prevent further subglottic inflammation and stenosis by laryngeal reflux.

Background/objectives: Mitomycin C (MMC) is used in the prevention of upper airway stenosis. However, the efficacy of MMC is still debatable, and the potential complications of MMC use have been scarcely reported. We evaluated the efficacy and early complications of MMC in a wound model of the subglottis., Study Design: A randomized animal study., Methods: Sixty rabbits underwent a full-thickness injury to the posterior subglottis by diode laser. The animals were randomly assigned to three groups according to the different topical treatments of MMC 0.4 or 10 mg/mL or saline alone for 5 minutes. Animals were killed at 4 weeks, and gross and histologic findings were compared among different groups and 10 age-matched, non-wound, normal controls., Results: Thirty-two of the 60 (53%) animals died mainly of acute airway obstruction by necrotic debris, sloughs on, or cartilage collapse of the unhealed posterior subglottis during early weeks after wounding, higher in the MMC-treated animals (67%) than in the wound controls (25%) (P = .007). This resulted from the significant delay of wound healing in the MMC-treated groups compared with the wound controls (P = .012). The degree of subglottic stenosis was comparable among different groups (P > .8), although collagen deposition was significantly lower in the MMC-treated groups compared with the untreated controls (P = .036)., Conclusions: There was a significant risk of acute airway obstruction from delayed wound healing in rabbits that received subglottic laser wounding and MMC treatment. This risk should be considered in the use of MMC in clinical practice.

Objectives: Although difficult laryngeal exposure (DLE) is a common problem encountered during microlaryngosurgery, reliable predictors of DLE and grading systems of laryngeal exposure have been scarcely suggested in the field of laryngology. We propose a new classification of laryngeal exposure focusing on the extent of glottic visualization., Methods: We investigated physical parameters that could predict DLE; 73 patients underwent a physical examination including 15 parameters. During endotracheal intubation and suspension laryngoscopy, Cormack-Lehane and laryngeal exposure scores were obtained for each patient and compared with the parameters., Results: The patients' ages ranged from 23 to 77 years. The laryngeal exposure score was correlated with the Cormack-Lehane score (p < .001, r = 0.469). Of all parameters, body mass index, neck circumference, thyroid-mental distance, and horizontal thyroid-mental distance showed significant correlation with the laryngeal exposure score (p < .05). From analysis of the candidate parameters in 13 patients with DLE and the non-DLE group, we found that the cutoff values for predicting DLE were a body mass index of > 25.0 kg/m2, a neck circumference of > 39.5 cm, a thyroid-mental distance of < 5.5 cm, and a horizontal thyroid-mental distance of < 4.0 cm., Conclusions: According to the proposed classification of laryngeal exposure, patients with obesity, a muscular neck, or retrognathia are likely to present DLE, and preoperative measurement of the predictors may be useful in preparing for microlaryngosurgery.

Interruption of the inferior vena cava (IVC) with azygos continuation is an uncommon vascular anomaly that results from aberrant development during embryogenesis. We report a rare case of this anomaly, presenting with massive pulmonary embolism. Subsequent evaluation with abdominal CT scan revealed the congenital absence of retrohepatic IVC. The patient was successfully treated with anticoagulation. When deep venous thrombosis (DVT) develops in patients with no apparent risk factors, the presence of congenital IVC anomalies should be considered.