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BACKGROUND Although several prospective studies have reported the efficacy of stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC), treatment-related toxicity varies and has not been determined. Therefore, the authors evaluated the safety and efficacy of SBRT for patients with HCC in a hepatitis B virus-endemic area. METHODS This multicenter phase 2 trial enrolled patients with unresectable HCC. Patients received SBRT with 45 to 60 Gy in 3 fractions. To evaluate gastroduodenal toxicity, esophagogastroduodenoscopy (EGD) was performed before and 2 months after SBRT. The primary endpoint was treatment-related severe toxicity at 1 year after SBRT. The secondary endpoints were the 2-year local control, progression-free survival, and overall survival rates. RESULTS In total, 74 patients were enrolled between January 2012 and April 2015, and 65 eligible patients were analyzed. One patient experienced radiation-induced liver disease with acute grade ≥3 toxicity 1 month after SBRT. In addition, 1 patient had a grade 3 esophageal ulcer with stenosis 5 months after SBRT. The actuarial rate of treatment-related severe toxicity at 1 year was 3%. The pre-SBRT and post-SBRT EGD findings were not significantly different among the 57 evaluable patients who underwent EGD. The 2-year and 3-year local control rates were 97% and 95%, respectively. The progression-free and overall survival rates were 48% and 84% at 2 years, respectively, and 36% and 76% at 3 years, respectively. CONCLUSIONS With a median follow-up of 41 months, this prospective multicenter study demonstrated that SBRT for patients with HCC is well tolerated and is an effective treatment modality.

All-solid-state lithium-ion batteries (ASLBs) employing sulfide solid electrolytes are attractive next-generation rechargeable batteries that could offer improved safety and energy density. Recently, wet syntheses or processes for sulfide solid electrolyte materials have opened opportunities to explore new materials and practical fabrication methods for ASLBs. A new wet-chemical route for the synthesis of Li-deficient Li3-x PS4 (0≤x≤0.3) has been developed, which is enabled by dual solvents. Owing to its miscibility with tetrahydrofuran and ability to dissolve elemental sulfur, o-xylene as a cosolvent facilitates the wet-chemical synthesis of Li3-x PS4 . Li3-x PS4 (0≤x≤0.15) derived by using dual solvents shows Li+ conductivity of approximately 0.2 mS cm-1 at 30 °C, in contrast to 0.034 mS cm-1 for a sample obtained by using a conventional single solvent (tetrahydrofuran, x=0.15). The evolution of the structure for Li3-x PS4 is also investigated by complementary analysis using X-ray diffraction, Raman, and X-ray photoelectron spectroscopy measurements. LiCoO2 /Li-In ASLBs employing Li2.85 PS4 obtained by using dual solvents exhibit a reversible capacity of 130 mA h g-1 with good cycle retention at 30 °C, outperforming cells with Li2.85 PS4 obtained by using a conventional single solvent.

Objective Many studies have described constructing a prediction model for bacteremia in community-acquired pneumonia (CAP), but these studies were not validated in external heterogeneous groups. The objective of this study was to test the generalizability of a previous bacteremia prediction model for CAP by external validation. Methods This multicenter retrospective cohort analysis was performed in eight tertiary urban hospital emergency departments (ED). We reviewed adult patients who were hospitalized after presentation to the ED with CAP. We categorized the enrolled patients into three groups according to the bacteremia prediction model score and calculated the number of patients with or without a blood culture-positive result. We performed a multivariable analysis to identify significant predictors for bacteremia. Results Among the enrolled 2,001 patients, 1,592 (79.6%), 371 (18.5%), and 38 (1.9%) were stratified to a low, moderate, and high-risk group, respectively, and this proportion was similar with previous study. Each group had a bacteremia-positive rate as follows: 1.2% for the low-risk group, 7.2% for the moderate-risk group, and 31.5% for the high-risk group. The area under the receiver operating characteristic curve for the bacteremia model in the external validation cohort was 0.81, and there was no significant difference with that of the previous internal validation cohort (p = 0.246). Assuming that blood cultures were not performed in the low-risk patients, the sensitivity and specificity of this model were 0.68 and 0.81, respectively. Additionally, the positive predictive value and negative predictive value were 9.54% and 98.87%, respectively. A platelet count less than 130,000 cell/μL, albumin less than 3.3 mg/dL, and C-reactive protein (CRP) greater than 17 mg/dL were identified as significant predictors with a sensitivity and specificity of, 0.70 and 0.83, respectively. Conclusion The bacteremia prediction model was well validated in the general population and could help physicians make the decision to reduce the number of blood cultures in patients with CAP. This article is protected by copyright. All rights reserved.

Background We recently reported that chronic cholesterol depletion in NCI-H292 cells by lovastatin suppresses interleukin (IL)-1β–induced MUC5AC gene expression. However, as there are numerous statins affect MUC5AC expression, we sought to determine which statin is most effective in reducing MUC5AC expression, and whether this activity of statins is related to IL-1 receptor (IL-1RI) and mitogen-activated protein kinase (MAPK) activity. Methods Four statins, namely atorvastatin, fluvastatin, lovastatin, and simvastatin, were tested. Cholesterol depletion was measured via modified microenzymatic fluorescence assay and filipin staining. NCI-H292 cells were pretreated with 10 μM of each statin for 1 hour, 10 ng/mL of IL-1β was added, and cells were then co-incubated with statin and IL-1β for 24 hours. MUC5AC mRNA expression was measured via real-time polymerase chain reaction (PCR). The phosphorylation levels were assayed by Western blot. Results Cholesterol in the plasma membrane was markedly decreased by all 4 statins, of which atorvastatin was the most potent. IL-1β–induced MUC5AC messenger RNA (mRNA) expression was most significantly decreased by 10 μM atorvastatin, to 1.4 ± 0.2-fold of the level of the untreated control group, as opposed to an increase to 4.7 ± 0.5-fold for IL-1β alone, and this suppression of MUC5AC expression was dose-dependent. This decrease in MUC5AC expression by atorvastatin was mediated via the IL-1 receptor and the MAPK pathway, including both phospho-p38 MAPK and phospho–extracellular signal-regulated kinase (phospho-ERK). Conclusion These results suggest that atorvastatin is the most potent of the assayed statins with respect to suppression of IL-1β–induced MUC5AC mRNA expression, and may be considered as an anti-hypersecretory agent.

An all-solid-state lithium battery based on a sulfide electrolyte is one of the most promising next-generation energy storage systems. However, the high interfacial impedance, particularly due to the internal pores in the electrode or electrolyte layers, is the major limiting factor to the development of sheet-type all-solid-state batteries. In this study, a low-resistance integrated all-solid composite electrode is developed using a hybrid of a pyrrolidinium-based ionic liquid and a polyethylene oxide polymer with lithium salt as a multifunctional interphase material, which is engineered to be compatible with the sulfide electrolyte as well as the fabrication process of sheet-type composite electrode. The interphase material fills the pore in the composite sheet while binding the components together, which effectively increases the interfacial contact area and strengthens the physical network between the components, thereby enabling enhanced ion transport throughout the electrode. The interphase-engineered sheet-type LiNi0.8 Co0.1 Mn0.1 O2 /Li10 GeP2 S12 electrode shows a high reversible capacity of 166 mAh g-1 at 25 °C, corresponding to 92% of the observed capacity in a current liquid-based cathode system, as well as enhanced cycle and rate performances. This study proposes a novel and practical method for the development of high-performance sheet-type all-solid-state lithium batteries.

Objectives/Hypothesis: The study group for sinonasal tumors at the Korean Rhinologic Society analyzed the results of the Korean multicenter experience for sinonasal inverted papilloma (IP) surgeries. Study Design: Multicenter cohort study and retrospective analysis. Methods: In total, 939 patients diagnosed with sinonasal IP treated between 1998 and 2007 at 17 university hospitals were enrolled. Demographic data and information about previous surgeries, the origin and involved site of the tumor, the surgical approach, follow-up duration, recurrence, and the presence of malignancy were collected. There were 361 patients whose follow-up was 3 years is required. Moreover, surgeons should always consider combined approaches to reduce the chances of recurrence.

EGb 761, extracted from Ginkgo biloba leaves, has been proven to induce caspase-3-dependent apoptosis in oral cavity cancer cells. Since EGb 761 is a composition of various components, it is important to identify which components are responsible for its anticancer effects to reduce the total dosage and to avoid toxicity. Therefore, the study aimed to determine the effective compounds of EGb 761 that induce apoptosis in oral cavity cancer cells and to identify whether caspase-3 was involved in apoptosis of oral cancer cells by EGb 761 components. The results of cell proliferation assays on oral cavity cancer cells showed that kaempferol and quercetin significantly inhibited cellular proliferation at a concentration of 40 microM. Flow cytometry showed that the antiproliferative effects of each component were due to increased apoptosis. Kaempferol and quercetin induced apoptosis in various oral cancer cell lines (SCC-1483, SCC-25 and SCC-QLL1) and showed cleavage of poly (ADP-ribose) polymerase (PARP). Caspase-3 activity assay revealed that induction of apoptosis by kaempferol and quercetin was caspase-3-dependent. In conclusion, the results suggest that kaempferol and quercetin, two components of EGb 761, effectively induce caspase-3-dependent apoptosis of oral cavity cancer cells and can be considered as possible anti-oral cavity cancer agents.

According to our previous study, Ginkgo biloba extract (GBE) suppresses IL-1beta-induced MUC5AC gene expression in NCI-H292 cells via the ERK and p38 MAPK pathways. This study sought to identify which ingredients of GBE suppress IL-1beta-induced MUC5AC gene expression in NCI-H292 cells and to examine which MAPKs are related to MUC5AC gene suppression for each ingredient. After the cells were pretreated with each ingredient and treated with IL-1beta (10 ng/mL), MUC5AC mRNA expression was determined by RT-PCR and real-time PCR. The results showed that kaempferol (KP) and quercetin (QC) suppressed MUC5AC mRNA expression in a dose-dependent manner, both with significant inhibition starting from 40 microm (equal concentration to about a twelfth or thirteenth dose of GBE). MAPK proteins were determined by western blot analysis after pretreatment with KP, QC and GBE. All three suppressed the phosphorylation of ERK and p38 kinases. In conclusion, the data suggested that KP and QC, essential ingredients in GBE, may overcome the dose problem of GBE and play a valuable role, clinically, in controlling mucin hypersecretion in airway inflammation.

Objectives/Hypothesis: Although skin has been the most effective graft material for reconstructing the airway lumen, the use of squamous epithelium has many problems. If autologous airway squamous epithelium could differentiate into mucociliary epithelium after in vivo grafting, it could be an answer to these problems. In this study, we wanted to examine whether carrier-free nasal epithelial cell sheets composed of autologous squamous epithelium could be used as a substitute for skin in airway luminal reconstruction in three maxillectomy patients. Study Design: In vitro biochemical experiments with in vivo applications. Methods: We cultured nasal squamous epithelium from three maxillary cancer patients prior to maxillecotmy. These squamous cell sheets were grafted on the forearm free flap, and, after maxillectomy, the surgical defect was reconstructed with a prefabricated myocutaneous radial forearm free flap with the cultured nasal squamous epithelium. At 1 and 3 month intervals after the reconstructive surgery, the cultured cell grafted area was investigated with histologic phenotype, comparing the skin grafted area. Results: The autologous nasal squamous epithelial cell sheet differentiated into mucociliary epithelium without the crust or mucus stagnation that is usually observed in cases in which skin graft is used for airway reconstruction. Conclusions: We suggest that autologous cultured nasal squamous epithelium, which differentiates into mucociliary epithelium after in vivo grafting, can be used as a clinically relevant substitute for skin graft in airway luminal reconstruction.

Clinicians have encountered many variations of the middle turbinate. Previous descriptions of the middle turbinate were only focused on its size and shape and lacked surgical implications associated with endoscopic sinus surgery. Therefore, the aim of this study was to examine the surgical anatomy of the middle turbinate in hemisected cadaveric heads. The middle turbinates from 101 hemisections of adult Korean cadaveric heads were measured using digital calipers and a protractor. The middle turbinates were then classified according to their shape. The mean distance between the anterior attachment of the middle turbinate and the anterior attachment of the superior turbinate was 18.5 mm. The posterior end of the middle turbinate extended more posteriorly than that of the inferior turbinate in 40% of the cases, while in 26.3% of the cases, the posterior end of the inferior turbinate extended more posteriorly than that of the middle turbinate. The middle turbinate was classified into three types according to the shape of its anterior border. In type 1, the anterior border of the middle turbinate ran directly posteroinferiorly from its attachment to the conchal plate, and was observed in 45.3% of the cases. In type 2, the anterior border of the middle turbinate initially coursed inferiorly from the conchal plate and then turned in a posteroinferior direction. This type was observed in 44.2% of the cases. Type 3 involved 10.5% of the cases where the anterior border bulged anteriorly before it coursed posteroinferiorly. The information provided in this report should assist surgeons when performing partial middle turbinectomies.

Objective We investigated the surgical anatomy of the sphenopalatine artery. First, the location of the sphenopalatine foramen on the lateral nasal wall and the pattern of the main branches of the sphenopalatine artery from the sphenopalatine artery were studied. Second, the course of the posterior lateral nasal artery with respect to the posterior wall of the maxillary sinus, the perpendicular plate of the palatine bone, and the pattern of distribution of its branches on the fontanelle was determined. Third, the distribution pattern on the inferior turbinate was analyzed. Study Design Fifty midsagittal sections of randomly selected Korean adult cadaver heads with intact sphenoid sinus and surrounding structures were used in the study. Methods The mucosa on the sphenopalatine foramen and its surrounding mucosa were removed with a microscissors, a fine forceps, and a pick to expose the sphenopalatine artery under an operating microscope (original magnification ×6). Results The feeding vessels of the superior turbinate were from the septal artery in 36 cases (72%). The feeding vessels to the middle turbinate branch originated from the proximal portion of the posterior lateral nasal artery just after exiting the sphenopalatine foramen in 44 cases (88%). Some portion of the posterior lateral nasal artery ran anterior to the posterior wall of the maxillary sinus in 38%. The major feeding arteries to the fontanelle were from the inferior turbinate branch in 25 cases (50%). In most cases, the inferior turbinate branch was the end artery of the posterior lateral nasal artery (98%). Conclusions The study provides detailed information concerning the sphenopalatine artery, which we hope will help explain the arterial bleeding that may occur during ethmoidectomy, middle meatal antrostomy, conchotomy, and endoscopic ligation of the sphenopalatine artery.

The possible breakdown of chlorophyll by irradiation was investigated. Chlorophyll b standard (3 ppm) was added to a methanol solution containing 1% linoleic acid. Irradiation up to 20 kGy was performed with or without N2-bubbling, and nonirradiated control was also prepared. Residual chlorophyll b content was analyzed by HPLC and UV-visible spectra after irradiation, and color was measured during 6 h of light exposure (3,300 lux, light intensity) to induce photooxidation. The added chlorophyll b was destroyed by irradiation at 20 kGy with or without N2-bubbling. With N2-bubbling the oil sample did not develop lipid oxidation during irradiation, and irradiated samples did not develop photooxidation during storage under light. Without N2-bubbling, irradiated oil samples had higher PV than nonirradiated samples. The Hunter color a-value of oil increased and the b-value decreased with irradiation at 20 kGy. UV-visible spectra also supported the break-down of chlorophyll b in solution by irradiation. Irradiation at 2.5 kGy or above destroved all added chlorophyll b. The results indicate that irradiation technology could be applied to reduce or eliminate the residual chlorophyll in oil processing without developing lipid oxidation during the irradiation process, which would prolong the shelf life of oil products by protecting them from photooxidation during display.

Objectives Although complete anatomical knowledge of the nasofrontal duct has been of great importance, little is known about it. The aim of this study is to examine the drainage site of the nasofrontal duct and to investigate the anatomical boundaries of the nasofrontal duct according to the drainage site. Study Design One hundred sagittally divided adult head specimens were analyzed by computed tomography and dissection under the surgical microscope. Methods Computed tomography scans of 50 adult cadaver heads were taken sagittally at 1-mm intervals and coronally at 3-mm intervals to find the nasofrontal duct. One hundred specimens, made up of sagittally divided adult cadaver heads, were dissected under the microscope to study the structure of the nasofrontal duct. Results We identified the anterior, posterior, medial, and lateral boundaries of the nasofrontal duct. In the most common type, the superior portion of the uncinate process formed the anterior border and the superior portion of the bulla ethmoidalis formed the posterior border of the nasofrontal duct. The conchal plate formed the medial border and the suprainfundibular plate formed the lateral border of the nasofrontal duct. Other variations are described in detail. Conclusions To widen the nasofrontal communication, removing the upper portion of the ground lamella of the ethmoid bulla, which is the posterior boundary of the nasofrontal duct, with cutting forceps seems to be a safe and easy method.

Objectives To investigate the exact anatomical structure of the lamellas in the ethmoid sinus by computed tomography (CT) and anatomical analysis. Study Design Cadaver dissections and CT scans were used to compare lamellar structures and their radiological images. Methods Anatomical microdissection of 100 midsagittal sections from adult cadaver head specimens were examined and compared with those of sagittal CT scans at 1-mm intervals. Results The posteroinferior end of the uncinate process attaching to the inferior turbinate divided the fontanelle into the anterior and posterior portions in the majority of cases. The basal lamellas of the bulla ethmoidalis were subdivided into three major types. The posteroinferior portion of its basal lamella was connected to the lower horizontal portion of the third basal lamella in all cases. The anterior indentation of the third lamella was identified in nine cases, but there was no indentation in the posterior direction. The basal lamella of the superior turbinate was attached to the skull base superiorly either separately or fused to the third lamella, and its posteroinferior portion was attached to the lowest portion of the anterior wall of the sphenoid sinus. The supreme turbinate existed in 50 cases; however, its basal lamella was identified in only 15 cases. Conclusions Our results indicate that the lamellas of the ethmoid sinus have relatively uniform patterns, although there is variability in shape. It is hoped that this study will provide surgeons with a more detailed structure of the basal lamellas for better surgical results and lower complication rates.

Objectives:Verify whether one’s external appearance may change after correction of caudal septal deflection by estimating nasal angle parameters.Methods:Correction of caudal septal deflection was performed by first releasing the caudal septal cartilage along the maxillary crest and excising excessive portions. The incised cartilage was sutured, and the detached ventral cartilage of caudal septum was fixed at the midline. Preoperative and postoperative photographs (lateral view) were taken at postoperative 6 months. Nasolabial angle (NLA) and nasal tip angle (NTA), as well as the angle between the columella and a perpendicular line to the Frankfort line (CFL), were evaluated. The visual analogue score (VAS) for nasal obstruction was evaluated at pre- and post-operation.Results:A total of 35 patients per protocol were included in this study. The mean preoperative NLA was 98.67±9.17° and the mean NLA at postoperative 6 months was 98.64±9.27°; the NTA changed from 84.41±6.96° to 84.33±7.07°; the CFL changed f...

Objective: Chronic rhinosinusitis (CRS) is one of the most common inflammatory diseases with multiple etiologies. Despite its high prevalence, risk factors influencing its prevalence have not been thoroughly revealed. Therefore, we investigated the prevalence and risk factors of CRS in Korea.Method: The 4,098 subjects that participated in the Korea National Health & Nutrition Examination Survey were included in the study. Risk factors were categorized into socio-demographic and personal medical factors. Univariate and multivariate analysis were performed to identify significant risk factors of CRS.Results: The prevalence of CRS in Korea was 6.95%. Among socio-demographic factors, male sex, old age, and heavy stress were significantly related with CRS. Influenza vaccination, septal deviation, and persistent allergic rhinitis were significant personal medical risk factors of CRS. Among these risk factors, persistent/moderate to severe allergic rhinitis was proven to be the most significant risk factor for C...

Objectives: Mucus hypersecretion is a characteristic feature in chronic sinusitis with nasal polyps. The objective of this study is to examine whether the polyp epithelium itself contributes to a certain extent to the increased mucous secretions in chronic sinusitis with nasal polyps, and if it does, to determine which mucin genes are responsible for the increased mucin secretion. Methods: Three pooled samples of normal nasal epithelial cells from each subject were obtained by scrapings from the inferior turbinates of 30 healthy adult volunteers and nasal polyps from 6 patients who underwent intranasal ethmoidectomy and polypectomy. Isolated epithelial cells were used for total RNA isolation for reverse transcriptase polymerase chain reaction and cell lysates for immunoblotting. Results: The intracellular level of mucin from polyp epithelium was 2.9 times higher than that of normal nasal epithelium (P < .05). Interestingly, MUC2 and MUC8 messenger RNA (mRNA) levels were clearly upregulated in polyp epithelium compared with those of normal turbinate epithelium. Conclusions: Polyp epithelium can be considered to contribute in part to increased secretion in chronic sinusitis with polyps, and increased mucous secretion might be related to the increased mRNA level of MUC2 or MUC8 or both.

Objectives: The blood supply to the nasal tip and columella was examined to determine whether it could be damaged as a result of transcolumellar incision during an external rhinoplasty approach in Asians. Methods: The blood vessels that supply the nasal tip were examined by dissecting 51 cadavers, and their corresponding 102 nasal sections were injected with red latex before dissection. The size and distribution of the vessels were measured with the unaided eye and the primary supply vessels were determined. The subdermal layer in which the vessels lie and the course of the vessels were also investigated. Results: The main blood supply source of the nasal tip proved to be the lateral nasal artery in 78% (80/102) of the cases examined, while the remaining cases (22%) received their blood supply via the dorsal nasal artery. Columellar branches were narrow in diameter and varied in size and appearance, and were therefore appeared insufficient as a main blood supply. These arteries passed through the musculoaponeurotic layer, but they were also in close proximity to the main surgical plane in the dome of the lower lateral cartilage. Conclusions: The authors speculate that the nasal tip blood supply in Asians is primarily derived from the lateral nasal or dorsal nasal arteries, with a variable contribution from the columella arteries. Therefore, it is important to correctly determine the surgical plane below the musculoaponeurotic layer in order to prevent skin flap necrosis or nasal tip deformity that may occur from damage to the main vessel during an external rhinoplasty approach.

Objectives: Although a complete anatomic knowledge of the fontanelle is a prerequisite to perform a surgical antrostomy opening, little is known about the boundary, shape, and size of the fontanelle. The purpose of this paper is to determine the best site for maintaining the patency of a surgical antrostomy opening by defining the anatomic boundaries, shape, and size of the fontanelle as well as its histological structure. Materials and Methods: One hundred sagittally divided heads were utilized. Mucosa overlying the lateral nasal wall was carefully removed with an operating microscope under 6× magnification. In some cases, a double mucous membrane, including the posteroinferior portion of the uncinate process, was cut as a whole and embedded in paraffin. The sections were stained with H&E. Results: The boundary of the fontanelle and the location of the natural ostium were described in detail. Eight patterns of the posteroinferior portion of the uncinate process were observed. There were three major fontanelle shapes when observed from the medial aspect to the lateral: triangular, pencil-like, and oval. The triangular type was the most common. The anterior portion of the fontanelle was shorter than the posterior when observed medially and was wider than the posterior portion when observed inferiorly. Conclusions: The anterior portion of the fontanelle is more prone to stenosis than the posterior portion. An antrostomy in the posterior fontanelle may be more ideal for a middle meatal antrostomy of the maxillary sinus.