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Background Human carbonyl reductase 1 (CBR1) plays major roles in protecting cells against cellular damage resulting from oxidative stress. Although CBR1-mediated detoxification of oxidative materials increased by stressful conditions including hypoxia, neuronal degenerative disorders, and other circumstances generating reactive oxide is well documented, the role of CBR1 under ionising radiation (IR) is still unclear. Methods The formalin-fixed and paraffin-embedded tissues of 85 patients with head and neck squamous cell carcinoma (HNSCC) were used to determine if CBR1 expression effects on survival of patients with treatment of radiotherapy. Subsequently colony formation assays and xenograft tumor mouse model was used to verify the relationship between CBR1 expression and radiosensitivity in HNSCC cells. Publicly-available data from The Cancer Genome Atlas (TCGA) was analysed to determine if CBR1 expression affects the survival of patients with HNSCC. To verify CBR1-mediated molecular signalling pathways, cell survival, DNA damage/repair, reactive oxygen species (ROS), cell cycle distribution and mitotic catastrophe in HNSCC cells with modulated CBR1 expression by knockdown or overexpression were measured using by colony formation assays, flow cytometry, qRT-PCR and western blot analysis. Results HNSCC patients with low CBR1 had a significantly higher survival rate than the high CBR1 expression (84.2% vs. 57.8%, p = 0.0167). Furthermore, HNSCC patients with low CBR1 expression showed a good prognosis for IR compared to patients with highly expressed CBR1. Also, we found that IR upregulated CBR1 mRNA via Nrf2 activation in HNSCC cells and patients. In vitro analysis, we found that CBR1-specific siRNA or inhibitor significantly enhanced radiosensitivity after IR, while CBR1 overexpression decreased. CBR1 inhibition by siRNA or inhibitor treatment accumulated cellular ROS leading to aberrant DNA damage repair and an increase of mitotic catastrophe. Moreover, the combination of CBR1 depletion with IR dramatically inhibited primary tumour growth in a xenograft tumor mouse model. Conclusion Our findings indicate that CBR1 has a key role in DNA damage response through regulation of IR-mediated ROS generation. Consistently, CBR1 expression is highly correlated with patient survival after and susceptibility to radiation therapy. Therefore, CBR1 inhibition with IR might be a potent therapeutic strategy for HNSCC treatment. Electronic supplementary material The online version of this article (10.1186/s13046-018-0942-9) contains supplementary material, which is available to authorized users.

For mucinous ovarian cancer (MOC), standard platinum-based therapy is largely ineffective. We sought to identify possible mechanisms of oxaliplatin resistance of MOC and develop strategies to overcome this resistance. A kinome-based siRNA library screen was carried out using human MOC cells to identify novel targets to enhance the efficacy of chemotherapy. In vitro and in vivo validations of antitumor effects were performed using mouse MOC models. Specifically, the role of PRKRA/PACT in oxaliplatin resistance was interrogated. We focused on PRKRA, a known activator of PKR kinase, and its encoded protein PACT because it was one of the five most significantly downregulated genes in the siRNA screen. In orthotopic mouse models of MOC, we observed a significant antitumor effect of PRKRA siRNA plus oxaliplatin. In addition, expression of miR-515-3p was regulated by PACT–Dicer interaction, and miR-515-3p increased the sensitivity of MOC to oxaliplatin. Mechanistically, miR-515-3p regulated chemosensitivity, in part, by targeting AXL. The PRKRA/PACT axis represents an important therapeutic target in MOC to enhance sensitivity to oxaliplatin.

Hepatocellular carcinoma (HCC) is a heterogeneous disease. Mouse models are commonly used as preclinical models to study hepatocarcinogenesis, but how well these models recapitulate molecular subtypes of human HCC is unclear. Here, integration of genomic signatures from molecularly and clinically defined human HCC (n = 11) and mouse models of HCC (n = 9) identified the mouse models that best resembled subtypes of human HCC and determined the clinical relevance of each model. Mst1/2 knockout (KO), Sav1 KO, and SV40 T antigen mouse models effectively recapitulated subtypes of human HCC with a poor prognosis, whereas the Myc transgenic model best resembled human HCCs with a more favorable prognosis. The Myc model was also associated with activation of β-catenin. E2f1, E2f1/Myc, E2f1/Tgfa, and diethylnitrosamine (DEN)-induced models were heterogeneous and were unequally split into poor and favorable prognoses. Mst1/2 KO and Sav1 KO models best resemble human HCC with hepatic stem cell characteristics. Applying a genomic predictor for immunotherapy, the six-gene IFNγ score, the Mst1/2 KO, Sav1 KO, SV40, and DEN models were predicted to be the least responsive to immunotherapy. Further analysis showed that elevated expression of immune-inhibitory genes (Cd276 and Nectin2/Pvrl2) in Mst1/2 KO, Sav1 KO, and SV40 models and decreased expression of immune stimulatory gene (Cd86) in the DEN model might be accountable for the lack of predictive response to immunotherapy. Implication: The current genomic approach identified the most relevant mouse models to human liver cancer and suggests immunotherapeutic potential for the treatment of specific subtypes. Mol Cancer Res; 16(11); 1713–23. ©2018 AACR.

Respiratory syncytial virus (RSV) infections are associated with significant morbidity and mortality. Inflammation is mediated by cytokine secretion from RSV‑infected airway epithelial cells. Grape seed proanthocyanidin extract (GSPE) exhibits potent antioxidant capacity, as well as anti‑bacterial, anti‑viral, anti‑carcinogenic, anti‑inflammatory and anti‑allergic actions. However, few studies have explored the anti‑inflammatory effects of GSPE on airway epithelial cells infected with RSV. Airway epithelial A549 cells were pretreated with GSPE and its effects on cytokine production during RSV infection were investigated. A549 cells were infected with RSV, with or without GSPE pretreatment, and cultured for 24, 48 and 72 h. The expression of interleukin (IL)‑1β, IL‑6 and IL‑8, were measured by reverse transcription‑quantitative polymerase chain reaction, ELISA and western blotting. RSV infection induced significant increases in proinflammatory cytokine expression. However, GSPE pretreatment decreased the mRNA and protein expression levels of IL‑1s, IL‑6 and IL‑8. GSPE regulated the immune response by reducing the RSV‑induced transcription of proinflammatory cytokines in airway epithelial cells, suggesting that GSPE helps to prevent RSV‑induced airway disease.

Detection of salivary pepsin has been given attention as a new diagnostic tool for laryngopharyngeal reflux (LPR) disease, because saliva collection is non-invasive and relatively comfortable. In this study, we prepared polypyrrole nanocorals (PPNCs) on a screen-printed carbon electrode (SPCE) by a soft template synthesis method, using β-naphthalenesulfonic acid (NSA) (for short, PPNCs/SPCE). Gold nanoparticles (GNPs) were then decorated on PPNCs/SPCE by electrodeposition (for short, GNP/PPNCs/SPCE). To construct the immunosensor, pepsin antibody was immobilized on GNP/PPNCs/SPCE. Next, citric acid was applied to prevent non-specific binding and change the electrode surface charge before pepsin incubation. Electrochemical stepwise characterization was performed using cyclic voltammetry, and immunosensor response toward different pepsin concentrations was measured by differential pulsed voltammetry. As a result, our electrochemical immunosensor showed a sensitive detection performance toward pepsin with a linear range from 6.25 to 100 ng/mL and high specificity toward pepsin, as well as a low limit of detection of 2.2 ng/mL. Finally, we quantified the pepsin levels in saliva samples of LPR patients (n = 2), showing that the results were concordant with those of a conventional ELISA method. Therefore, we expect that this electrochemical immunosensor could be helpful for preliminarily diagnosing LPR through the detection of pepsin in saliva.

Objectives/Hypothesis Endoscope-assisted transoral removal of a thyroglossal duct cyst (TGDC) has been introduced to clinical practice. However, the technical feasibility, efficacy, and safety of this procedure have not been studied. Herein, we conducted a prospective clinical trial to evaluate endoscope-assisted transoral removal of a TGDC. Study Design Prospective cohort study. Methods Thirty patients were included. We performed endoscope-assisted transoral removal of TGDCs and evaluated the clinical results and complications over more than 2 years. Results Endoscope-assisted transoral resection was successful in all cases. However, transient morbidity was noted in one patient. The mean operation time was 67.33 ± 17.26 minutes. Surgery was not required for recurrence or revision during a follow-up. Conclusions Endoscope-assisted transoral resection of a TGDC is a potentially safe and effective procedure leading to excellent functional and cosmetic outcomes. Additionally, considering the embryological development of TGDCs, the transoral approach can open a new access route to these cysts. Level of Evidence 2b. Laryngoscope, 2015

Objectives Fas is the prototypic representative of the death receptor subgroup of the tumor necrosis factor (TNF) receptor family. Recently, single nucleotide polymorphisms (SNPs) of the Fas or Fas ligand (FasL) genes have been shown to be associated with an increased risk of several cancers and with the prognosis of several cancers. The objective of this study was to evaluate the association between the SNPs of the Fas and FasL genes and papillary thyroid cancer (PTC) and to assess the relationship between these SNPs and the clinicopathological characteristics of PTC. Methods Five SNPs located within the two genes of Fas and FasL were genotyped using direct sequencing in 94 patients with PTC and 364 healthy controls. Genetic data were analyzed using commercially available software. And, the statistical analyses were performed according to clinicopathologic characteristics of PTC. Results Genotyping analysis demonstrated that the intron SNP (rs1571013), promoter SNP (rs1800682) and 3′-UTR SNP (rs1468063) of Fas were significantly associated with the development of PTC. We also detected a significant difference between patients with PTC and healthy controls with respect to Fas gene allele frequencies. Furthermore, we found that the 3′-UTR SNP (rs1468063) of Fas was associated with the multifocality of cancer [dominant model, OR 0.28, p = 0.028; log-additive model, OR 0.43, p = 0.033]. Conclusion We observed a significant association between SNPs of the Fas gene and the development of PTC. In addition, there was a significant association between a Fas SNP and the multifocality of PTC.

Background The purpose of this study was to identify the prevalence of sialoceles and the risk factors associated with their formation after parotidectomy. Methods We performed a retrospective analysis of the data from consecutive patients who underwent partial superficial parotidectomy of parotid tumors. Demographic data, preoperative imaging results, operative variables, including tumor type, incision type, tumor size, and method of parenchymal disruption were assessed. Results Twenty-three of 357 patients (6.4%) undergoing partial superficial parotidectomy developed sialoceles during the postoperative period. Sialoceles occurred more often in patients who had tumors in the anterior portion of the parotid gland. Multivariate analysis showed that an anterior tumor location was a significant risk factor for sialocele formation. Conclusion The incidence of sialocele development was 6.4% in patients undergoing partial superficial parotidectomy. An anterior tumor location may increase the risk of sialocele formation. © 2015 Wiley Periodicals, Inc. Head Neck 38: E941–E944, 2016

There continues to be a paucity of data regarding the nanostructural changes of vocal fold (VF) collagen after injury. The aim of this study is to investigate the nanostructural and morphological changes in the rabbit VF lamina propria following acute injury using atomic force microscopy (AFM). Unilateral VF injury was performed on 9 New Zealand breeder rabbits. Sacrifice and laryngeal harvest were performed at three time points: 1 day, 3 days, and 7 days after injury. Histology and immunohistochemistry data were collected to confirm extracellular matrix (ECM) changes in rabbit VF. The progressive changes in thickness and D-spacing of VF collagen fibrils were investigated over a 7-day postinjury period using AFM. At post-injury day 1, a fibrin clot and inflammatory cell infiltration were observed at the injured VF. The inflammatory score at postinjury day 1 was highest in injured VF tissue, with a significant decrease at postinjury day 7. The immunoreactivity of inflammatory proteins (COX-2, TNF-α) was observed in VF up to day 7 after injury. AFM investigation showed clustered and disorganized collagen fibrils at the nanoscale resolution at post-injury day 7. Collagen fibrils in injured VF at postinjury day 7 were significantly thicker than control and postinjury days 1 and 3 (P

Background Although numerous recent studies have implicated a role for interleukin 17(IL17) in tumor development, the mechanisms of IL17 involvement are still uncharacterized. The aims of this study were to determine whether single nucleotide polymorphisms (SNPs) in IL17 and IL17R contribute to the development of papillary thyroid cancer (PTC) and to assess the relationship between IL17 and IL17R SNPs and the clinicopathologic characteristics of PTC. Materials and methods Eight SNPs located within the IL17A, IL17RA, and IL17RB genes were genotyped using direct sequencing in 94 patients with PTC and 260 patients without PTC (controls). Genetic data were analyzed using commercially available software. Statistical analyses were then performed to examine the relationships between these SNPs and the clinicopathologic characteristics of PTC. Results Genotyping analysis demonstrated that the IL17RA SNP rs4819554 (codominant model 1, odds ratio (OR) = 0.39, P = 0.001) and the IL17RB SNP rs1025689 (dominant model, OR = 0.59, P = 0.043) were significantly associated with lack of PTC. Interestingly, the IL17A SNP rs2275913 (codominant model 2, OR = 0.19, P = 0.034) was significantly associated with lack of multifocality. Furthermore, the IL17RA SNP rs4819554 (dominant model, OR = 0.25, P = 0.010) was significantly associated with lack of cancer bilaterality. Conclusion In this study of SNPs in the IL17 and IL17R genes in patients with PTC, we demonstrated that IL17RA polymorphisms can influence both the development and the bilaterality of PTC.

BACKGROUND: Although the benefits of early tracheostomy have been discussed in numerous studies, it is still unclear whether it is safe to perform early tracheostomy on unstable stroke patients. The purpose of this study is to assess the influences of the timing of tracheostomy on the incidence of complications following surgical tracheostomy in stroke patients. METHODS: We retrospectively performed chart reviews of 95 stroke subjects who underwent tracheostomy. In terms of timing, procedures performed within 7 d of intubation were categorized as early tracheostomy, and those performed after 7 d were categorized as standard tracheostomy. The incidence of complications following tracheostomy was compared between the two groups. The risk factors for complication were also investigated. RESULTS: Among the 95 subjects, 59 (62.1%) received early tracheostomy and 36 (37.9%) received standard tracheostomy. The overall incidence of tracheostomy complications was 24.2%, and there was no significant difference in incidence between the two groups. A comparison of risk factors between the groups with and without complications revealed no significant differences in age, sex, body mass index, Glasgow coma scale score, stroke type, or history of underlying disease. However, activated partial thromboplastin time was significantly higher in the group with complication. CONCLUSIONS: There was no significant difference in the incidence of complications in stroke subjects undergoing early versus standard tracheotomy.

Objectives/Hypothesis The aim of this study was to evaluate the clinicopathologic characteristics and pattern of lymph node (LN) metastasis in papillary thyroid cancer (PTC) located in the isthmus. Study Design Retrospective cohort study. Methods One hundred ninety consecutive patients with PTC who underwent total thyroidectomy and bilateral central neck dissection were analyzed. Preoperative ultrasonography was reviewed to identify PTC located in the isthmus. Clinicopathologic factors including age, sex, tumor size, extrathyroidal extension (ETE), margin, angiolymphatic invasion, and nodal metastasis were evaluated. Results Of 190 PTC patients, 14 patients (7.3%) had a tumor located in the isthmus. The PTCs located in the isthmus were more likely to have ETE and central LN involvement. Furthermore, PTCs located in the isthmus had a higher frequency of metastasis to pretracheal and prelaryngeal LNs than those located in the lobes. Conclusion PTCs located in the isthmus were associated with ETE and more likely to involve the pretracheal and prelaryngeal LNs. Level of Evidence 4 Laryngoscope, 2015

Summary Objectives Our study was designed to further evaluate the relationships between the saliva pepsin level and the symptoms and quality of life of patients with laryngopharyngeal reflux (LPR). Study design A prospective cohort study without controls. Setting Tertiary teaching hospital. Subjects and methods We analyzed 50 patients diagnosed with LPR by 24-hour multichannel intraluminal impedance pH monitoring. All subjects were instructed to collect saliva samples upon waking in the morning. The saliva pepsin levels were analyzed using enzyme-linked immunosorbent assay. The Reflux Symptom Index, Reflux Finding Score, Laryngopharyngeal Reflux-Health-Related Quality of Life, and Short Form 36 survey were administered. Results The pepsin was detected in the saliva of 41 patients with LPR (17.15 ± 20.42 ng/mL). Nine patients did not have pepsin in the saliva. There were no significant associations between the pepsin level in the saliva and Reflux Symptom Index, Laryngopharyngeal Reflux-Health-Related Quality of Life, or Short Form 36 of patients with LPR. Conclusion The saliva pepsin level is not significantly correlated with LPR symptoms or quality of life in LPR patients. It may be true that there is no association between pepsin levels and LPR symptoms, but this lack of association does not prove the lack of pathophysiological effect.

The aim of this study was to identify risk factors for transcervical approaches in the treatment of pediatric deep neck infections (DNIs).We performed a retrospective analysis of data from patients who were diagnosed with DNIs. All medical records were reviewed for demographic characteristics, presenting signs and symptoms, duration of symptoms, size of abscess, laboratory results, duration of intravenous (IV) antibiotic administration, duration of hospitalization, medical treatment, and type of surgical drainage (oral or transcervical approach). We divided 126 patients into three groups according to the approach used to treat the DNI: non-surgical, intraoral surgical and external transcervical surgical.The average ages of the non-surgical, intraoral, and transcervical groups were 10.46±5.27, 12.75±4.82 and 5.54±5.15years, respectively. The transcervical approach was used to treat younger patients (p0.001). Abscess size was significantly larger for the transcervical group compared to the other groups (5.72±8.93, 13.51±14.74, 18.36±16.05mm, non-surgical, intraoral, and transcervical group, respectively, p=0.009). The average duration of IV antibiotic administration for the transcervical group was 9.77±3.27days, which was significantly higher than those for the other groups (5.49±3.28 for non-surgical and 6.13±2.85 for intraoral, p0.001). Multivariate analysis revealed that submandibular abscesses (Exp (B)=5.254, p=0.012) were the only significant risk factor for the transcervical approach in surgical treatment of DNIs.Submandibular space abscesses were the only significant risk factor for the transcervical approach in the treatment of pediatric DNI patients.III.

This study measured and analyzed the position and dimension of genial tubercle (GT) and mental foramen (MF) STUDY DESIGN: Retrospective chart review study.Tertiary care teaching hospital.Two hundred ten subjects were included who received 3-dimensional (3D) facial computed tomography (CT), and the GT and MF were evaluated. Subjects were divided into 4 groups by gender and skeletal type. Seven variables were measured: (1) height of GT (GTH), (2) width of GT (GTW), (3) distance from apices of lower incisors to superior border of GT (LI-SGT), (4) distance from inferior border of GT to inferior border of mandible (IGT-IBM), (5) thickness of anterior mandible (MT), (6) distance from symphysis of mandible to MF (S-MF), and (7) distance from superior border of GT to inferior border of mandible (SGT-IBM).All the parameters showed marked differences in individuals. Class I males showed longer GTH, MT, and SGT-IBM than class I females (P.05). IGT-IBM and S-MF were longer in class II males than in class I females (P.05). LI-SGT and IGT-IBM also showed personal variation.Anatomical features of mandibular structures showed individual variations. GTH, IGT-IBM, MT, S-MF, and SGT-IBM also showed differences between the groups.

Summary Objective/Hypothesis To assess changes in the symptoms and quality of life (QOL) of patients diagnosed with laryngopharyngeal reflux (LPR) after proton pump inhibitor (PPI) treatment. Study Design Prospective study. Methods One hundred eighty patients diagnosed with LPR were evaluated. All patients were prescribed Lansoprazole (15 mg) twice daily for 12 weeks. The Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Short-Form 36-Item Health Survey version 2.0 (SF-36), and LPR–health-related quality of life (HRQOL) were collected from each patient at the initial visit and at 4- and 12-week follow-up visits. Results Significant improvement was observed in RSI and RFS scores after treatment. The LPR-HRQOL score also showed gradual improvement after PPI treatment in the voice, cough, throat clearing, swallowing, and overall impact of acid reflux. Although each domain of the SF-36 had a low score at the baseline visit, seven domains of the SF-36 had improved, except for the physical functioning domain. Conclusions We found that RSI, RFS, and most categories in the LPR-HRQOL and SF-36 improved 12 weeks after initiating PPI treatments. These findings indicate that PPI treatment for 3 months could improve the QOL of patients diagnosed with LPR.

Purpose Preoperative detection of bone invasion is important in cases of gingival cancer. The aim of this study was to compare the diagnostic value of 3 imaging methods for the detection of bone invasion in upper and lower gingival cancer: computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) and CT. Materials and Methods This retrospective cohort study enrolled patients who underwent a maxillectomy or a mandibulectomy for gingival cancer. Each preoperative image (CT, MRI, or PET/CT) was reviewed for the presence of bone invasion, and the possibility for bone invasion was graded. These results were verified with pathology reports. Sensitivity, specificity, positive predictive value, and negative predictive value for the detection of mandibular involvement in alveolar bone were calculated, and a receiver operating characteristics (ROC) curve analysis was performed. Results Forty patients (27 men and 13 women) were enrolled. Pathologic examination disclosed bone invasion in 25 of the 40 patients. Of these patients, 13 had maxillary and 12 had mandibular alveolus involvement. The diagnostic accuracy of CT (90.0%) was highest among the 3 modalities for the detection of bone invasion. In the ROC curve analysis, values for the area under the curve for upper gingival cancer were lower than those for lower gingival cancer. Conclusions The 3 imaging methods were less sensitive for the detection of bone invasion in upper gingival cancer than in lower gingival cancer. Cases of upper gingival cancer should be evaluated more carefully for bone invasion before surgery.

Penetrating neck injuries constitute 5-10% of all trauma cases. These injuries may cause life-threatening suppurative or vascular complications, but the severity and extent of damage depends upon the inflicting object and the involved structures. If significant complications are not expected, then it is best to leave the foreign body embedded and avoid surgical risks. We present a rare case of a foreign body embedded in the neck causing tinnitus and foreign body sensation.

This study was aimed to evaluate the change in positional dependency by analyzing polysomnographic data in non-responders who previously underwent multilevel surgery for obstructive sleep apnea. A total of 48 consecutive patients who had a

The association between polymorphism of CC chemokine ligand 5 (CCL5) and cancer has been reported in several studies, however, there is no data in papillary thyroid cancer (PTC).The aim of this study was to investigate whether a promoter single nucleotide polymorphisms (SNP) in CCL5 contributes to the development of PTC and assess the relationships between the CCL5 SNP and the cliniopathologic characteristics of PTC.One promoter SNP (rs2107538, -281C/T) in CCL5 was genotyped using direct sequencing in 93 PTC patients and 212 healthy controls. Genetic data were analyzed using SNPStats, Helixtree, and SNPAnalyzer. PTC patients were dichotomized and compared with respect to cliniopathologic characteristics of PTC.An association was evident between PTC and SNP (rs2107538) in CCL5 [codominant model 2 (T/T vs. C/C), OR = 2.74, 95% CI = 1.18-6.37, p = .019; dominant model, OR = 2.25, 95% CI = 1.01-5.03, p = .049; recessive model, OR = 1.73, 95% CI = 1.06-2.82, p = .030]. When the genetic relationships between SNP and subgroups of PTC patients were assessed, SNP rs2107538 in CCL5 was not associated with any clinicopathologic characteristics of PTC.SNP in the CCL5 -281 promoter gene could increase the risk of developing PTC in Koreans.

Background We investigated whether single nucleotide polymorphisms (SNPs) of integrin beta 1 (ITGB1) and integrin beta 2 (ITGB2) contribute to the development of papillary thyroid cancer (PTC). Methods Two synonymous SNPs (rs2230396 and rs2298141) of ITGB1 and 1 synonymous SNP (rs2352326), 1 5′ URT-region SNP (rs2070947), and 1 promoter SNP (rs2070946) of ITGB2 SNPs were genotyped using direct sequencing in 94 patients with PTC and 213 healthy controls. Genetic data were analyzed using SNPStats (http://bioinfo.iconcologia.net/SNPstats), Helix Tree (Golden Helix Inc, Bozeman, MT), and SNPAnalyzer (ISTECH Corp, Goyang City, Republic of Korea). Results The promoter SNP (rs2070946) of ITGB2 was significantly associated with the development of PTC (dominant model, log-additive model). The G allele frequencies of the promoter SNP (rs2070946) of ITBG2 in patients with PTC (19.9%) were increased by about 2-fold compared with controls (10.2%). Conclusions Our results suggest that a promoter SNP (rs2070946) of ITGB2 might be associated with a risk of PTC.

Objectives/Hypothesis To investigate voice change as a complication after uvulopalatopharyngoplasty (UPPP) with or without radiofrequency tongue base reduction (RTBR) in patients with obstructive sleep apnea. Study Design Before and after study. Methods Twenty-two patients with suspected velopharyngeal collapse only underwent uvulopalatopharyngoplasty (UPPP group). Twenty-five patients with velopharyngeal and retrolingual collapse underwent concurrent UPPP with RTBR (RTBR group). All patients were evaluated before surgery and at 8 weeks after surgery. Acoustic measures included mean fundamental frequency (mF0), maximal phonation time (MPT), jitter, shimmer, noise-to-harmonic ratio (NHR), hypernasality test, and the first three formant frequencies (F1, F2, F3) for sustained vowels. Voice handicap index (VHI) was used to determine subjective voice change. Results Postoperative values for mF0, MPT, jitter, shimmer, NHR, hypernasality test, and F1 did not significantly change in either group following surgery. There were the significant decreases at the F2 of /u/ and the F3 of /o/ in the UPPP group, and at the F2 of /o/ and the F3 of /a/, /i/, and /o/ in the RTBR group. Postoperative VHI score was increased only in the RTBR group. Conclusions UPPP and UPPP with RTBR have an impact on formant frequencies of vowels. Despite a relatively small number of patients, it is apparent that UPPP with RTBR influences VHI. Patients, especially professional voice users, should be advised of this before considering the surgery. Level of Evidence 4

Objectives To evaluate the predictive factor of epiglottic abscess and to investigate whether routine computerised tomography (CT) in patients with acute supraglottitis are necessary. Design A prospective and multicentre study. Settings Tertiary care referral medical centre. Participants A total of 202 patients with suspected acute supraglottitis were enrolled. All patients underwent CT to confirm the presence of abscess. Main outcome measures The patients' characteristics, symptoms at presentation, laryngoscopic findings of epiglottic swelling and arytenoid swelling by scope classification and initial laboratory finding were analysed. Results Of 202 patients, 158 (78%) had acute supraglottitis and 44 (22%) had epiglottic abscess. There was no significant difference in age between the acute supraglottitis group and the epiglottic abscess group. Men were significantly more frequent in the epiglottic abscess group than females (P = 0.042). When comparing the symptom at presentation, the patients with epiglottic abscess complained of voice change more frequently (P = 0.003). Moderate or severe epiglottic swelling in scope classification was significantly associated with epiglottic abscess (P

To compare the efficacy, relapse, and adverse effects between intralesional injection and mouth rinse of triamcinolone acetonide (TA) in patients with oral lichen planus (OLP).A randomized controlled study.College medical center.Forty consecutive patients, who had been diagnosed with OLP, were recruited. Participants were randomly divided into 2 groups using intralesional injection or mouth rinse of TA. The severity of pain and burning sensation on a 10-cm visual analog scale (VAS) and the Oral Health Impact Profile-14 (OHIP-14) were assessed at weeks 0, 1, 2, 3, 4, and 6. The signs of OLP were quantified using a special scoring system for OLP. The rate of relapse and the adverse effects were compared between both groups.The VAS scores for pain and burning mouth sensation and objective scoring for OLP were significantly improved at 1, 2, 3, 4, and 6 weeks in both groups. The changes in the VAS for burning mouth sensation, OHIP-14, and objective scoring for OLP were similar between both groups. The change in the VAS for pain from baseline to week 1 in the intralesional injection group was significantly higher than in the mouth rinse group. The rate of adverse effects was significantly higher in the mouth rinse group than in the intralesional injection group (44.4% vs 5.0%).The efficacies of both treatments were similar. The rate of adverse effects was significantly lower for intralesional injection of TA than mouth rinse of TA.

Background Respiratory syncytial virus (RSV) is reported as the most influential factor that triggers hyperreactivity of the airway and causes asthma in infants and children. However, the mechanisms remain to be elucidated. The study evaluated the changes in the levels of four types of histamine receptor (HR) and CC chemokines, such as eotaxin and regulated on activation, normal T cell expressed and presumably secreted (RANTES), in nasal epithelial cells and fibroblasts after RSV infection. Methods Nasal cavity mucosa attained from 20 patients who had undergone inferior turbinoplasty were cleaned by normal saline mixed with gentamicin. Each sample was divided in half. One-half was used for incubation of epithelial cells, and the other half was used for culturing fibroblasts. The levels of HR 1 (H1R), 2 (H2R), 3 (H3R), 4 (H4R), eotaxin, and RANTES were measured by real-time polymerase chain reaction 0, 12, and 36 hours after infection with RSV. Results H1R was significantly increased at 12 and 36 hours compared with 0 hours in both cell types. The level of H2R was significantly increased in epithelial cells from 0 to 36 and 12 to 36 hours and in fibroblasts from 0 to 12 and 0 to 36 hours. There were significant increases of H3R level in fibroblasts from 0 to 12 and 0 to 36 hours, and of H4R in epithelial cells and fibroblasts from 0 to 12 and 0 to 36 hours. Eotaxin and RANTES were also significantly increased in both epithelial cells and fibroblasts from 0 to 12 and 0 to 36 hours. Conclusion RSV infection increases the levels of all four HRs, especially H1R and H2R, as well as the levels of eotaxin and RANTES in nasal epithelial cells and fibroblasts. These findings suggest that RSV infection might cause respiratory tract hyperreactivity by increasing the content of HRs and CC chemokines.

Objective To evaluate the association between the parameters of 24-hour multichannel intraluminal impedance (MII)-pH monitoring and the symptoms or quality of life (QoL) in laryngopharyngeal reflux (LPR) patients. Design Prospective cohort study without controls. Setting University teaching hospital. Methods Forty five LPR patients were selected from subjects who underwent 24-hour MII-pH monitoring and were diagnosed with LPR from September 2014 to May 2015. Reflux Symptom Index (RSI), Health Related Quality of Life (HRQoL), Short Form 12 (SF-12) Survey questionnaires were surveyed. Spearman correlation was used to analyze the association between the symptoms or QoL and 24-hr MII-pH monitoring. Results Most parameters in 24-hr MII-pH monitoring showed weak or no correlation with RSI, HRQoL, and SF-12. Only number of nonacid reflux events that reached the larynx and pharynx (LPR-nonacid) and number of total reflux events that reached the larynx and pharynx (LPR-total) parameters showed strong correlation with heartburn in RSI (R=0.520, p < 0.001, R=0.478, p=0.001, respectively). Multiple regression analysis showed that there was only one significant regression coefficient between LPR-nonacid and voice/hoarseness portion of HRQoL (b=1.719, p=0.022). Conclusion Most parameters of 24-hour MII-pH monitoring did not reflect subjective symptoms or QoL in patients with LPR. This article is protected by copyright. All rights reserved.

The impact of occult lymph node metastasis on regional recurrence after prophylactic central neck dissection for preoperative, nodal-negative papillary thyroid cancer is controversial. We investigated risk factors for regional lymph node recurrence in papillary thyroid cancer patients who underwent total thyroidectomy and bilateral prophylactic central neck dissection. Analysis was according to clinicopathologic characteristics and occult lymph node metastasis patterns.This multicenter study enrolled 211 consecutive patients who underwent total thyroidectomy with bilateral prophylactic central neck dissection for papillary thyroid cancer without evidence of central lymph node metastasis on preoperative imaging. Clinicopathologic features and central lymph node metastasis patterns were analyzed for predicting regional recurrence. Multivariate Cox regression analysis was used to identify independent factors for recurrence.Median follow-up time was 43 months (24-95 months). Ten patients (4.7%) showed regional lymph node recurrence. The estimated 5-year, regional recurrence-free survival was 95.2%. Tumor size ≥1 cm, central lymph node metastasis, lymph node ratio, and prelaryngeal lymph node metastasis were associated with regional recurrence in univariate analysis (P .05). In multivariate analysis, a lymph node ratio ≥ 0.26 was a significant risk factor for regional lymph node recurrence (odds ratio = 11.63, P = .003). Lymph node ratio ≥ 0.26 was an independent predictor of worse recurrence-free survival on Cox regression analysis (hazard ratio = 11.49, P = .002).Although no significant association was observed between the presence of occult lymph node metastasis and regional recurrence, lymph node ratio ≥ 0.26 was an independent predictor of regional lymph node recurrence in papillary thyroid cancer patients who underwent total thyroidectomy and bilateral prophylactic central neck dissection.

The aim of this study was to evaluate the clinicopathologic characteristics and pattern of lymph node (LN) metastasis in papillary thyroid cancer (PTC) located in the isthmus.Retrospective cohort study.One hundred ninety consecutive patients with PTC who underwent total thyroidectomy and bilateral central neck dissection were analyzed. Preoperative ultrasonography was reviewed to identify PTC located in the isthmus. Clinicopathologic factors including age, sex, tumor size, extrathyroidal extension (ETE), margin, angiolymphatic invasion, and nodal metastasis were evaluated.Of 190 PTC patients, 14 patients (7.3%) had a tumor located in the isthmus. The PTCs located in the isthmus were more likely to have ETE and central LN involvement. Furthermore, PTCs located in the isthmus had a higher frequency of metastasis to pretracheal and prelaryngeal LNs than those located in the lobes.PTCs located in the isthmus were associated with ETE and more likely to involve the pretracheal and prelaryngeal LNs.4 Laryngoscope, 126:2419-2421, 2016.

Background and Objective The concept of tailor-made, multilevel surgery, including the nasal cavity, a multiple level of the pharynx, should be required to overcome the collapse at multiple levels of the upper airway because most patients show multilevel airway obstruction. The objective of this study was to evaluate the surgical results when the surgery was performed at the multilevel of the pharynx and in a tailor-made manner in obstructive sleep apnea (OSA) patients with multilevel obstruction in various evaluations of the obstruction site. Methods This is a retrospective analysis of data prospectively gathered on 86 OSA patients treated with multilevel surgery. Patients were evaluated with a questionnaire preoperatively and postoperatively at 1 month and more than 6 months, respectively. A polysomnography was used to evaluate the surgical results postoperatively at more than 6 months. Results Postoperative values for the questionnaire of both daytime and nighttime symptoms were significantly reduced after surgery. Daytime sleepiness checked by Epworth Sleepiness Scale (ESS) was significantly improved. The postoperative value of apnea-hypopnea index (AHI) was significantly improved after treatment. When the successful outcome was defined as a postoperative AHI < 5, 43.3% of patients met the criteria. The success rates of surgery among the groups according to severity were not statistically significant. Conclusions Multilevel surgery in a tailor-made manner shows relatively good results. This can be a solution for OSA patients when medical therapy, including nasal continuous positive airway pressure, is not tolerable. Precise and tenacious evaluation of the obstruction site is the key for increasing surgical success.

Bone morphogenetic proteins (BMPs) are members of the transforming growth factor beta (TGFβ) superfamily with well-described functions in bone formation. Although disrupted BMP signaling in tumor development has been investigated, a genetic association for BMP3 in papillary thyroid cancer (PTC) has remained largely unexplored. In this study, we investigated whether BMP3 single nucleotide polymorphisms (SNPs) are associated with the development of PTC and its clinicopathological features. A total of 103 PTC patients and 324 control subjects were enrolled. One promoter SNP (rs13138132; −1919C/A) and one missense mutation (rs3733549; Arg192Gln) in BMP3 were genotyped by direct sequencing. SNPStats, SNPAnalyzer, Helixtree and Haploview version 4.2 were used to evaluate the genetic data. Multiple logistic regression models were used to calculate odds ratios (ORs), 95% confidence intervals (CIs) and P-values. The missense SNP (rs3733549) was weakly associated with the development of PTC in a codominant model (AA vs. GG; P=0.017) and a recessive model (AA vs. GG/GA; P=0.023). Additionally, in an analysis according to clinicopathological features, rs13138132 was significantly associated with extra-thyroidal invasion in a codominant model (CA vs. CC; P=0.006) and a dominant model (CA/AA vs. CC; P=0.0023). We also identified that the frequency of the A allele in the promoter SNP (rs13138132) was increased in PTC patients with extrathyroidal invasion (P=0.004). Our data suggest that rs3733549 in BMP3 is associated with the development of PTC and that the A allele of rs13138932 in BMP3 is a risk factor for extrathyroidal invasion.

Objective Fungus may contribute to the development and exacerbation of allergic airway diseases. Several studies have demonstrated the presence of humoral immune responses to fungi, including Alternaria and Aspergillus, in patients with nasal polyposis, asthma, or rhinitis. The purpose of this study was to evaluate the role of Alternaria- and Aspergillus-specific IgE antibodies in allergic inflammation of adenoid tissue. Methods Thirty-nine atopic subjects who were sensitized to more than one common aeroallergen and 39 non-atopic subjects undergoing adenotonsillectomy were recruited. The Phadia ImmunoCAP was used to quantify total IgE, Alternaria- and Aspergillus-specific IgE, eosinophil cationic protein (ECP), and mast cell tryptase in adenoid tissue homogenates. Alternaria- and Aspergillus-specific IgE were detected in the adenoid tissues from some of the subjects (37.2% and 24.4%, respectively) without systemic sensitization to common airborne fungi. Results Both Alternaria- and Aspergillus-specific IgE were more prevalent in adenoid tissues from atopic children (48.7% and 38.5%, respectively) than in tissues from non-atopic children (25.6% and 10.3%, respectively). Subjects with high Alternaria-specific IgE level showed significantly higher serum and adenoid total IgE and adenoid ECP and tryptase than those without specific IgE. Alternaria-specific IgE levels were significantly correlated with serum and adenoid total IgE and with tryptase and ECP levels in adenoid tissue. Conclusions Adenoid tissues from atopic and non-atopic children displayed local IgE-mediated hypersensitivity to fungi in the absence of systemic fungal hypersensitivity. Locally-produced Alternaria-specific IgE may contribute to mast cell and eosinophil activation, especially in the presence of tissue eosinophilia.

Background The interleukin11 (IL11) and IL11 receptor alpha (IL11RA) are involved in cellular growth, differentiation, invasiveness, and tumor progression in several tumors. We investigated whether coding single nucleotide polymorphisms (cSNPs) of IL11 and promoter SNP IL11RA would contribute to the development of papillary thyroid cancer (PTC). We also assessed the relationships between IL11 and IL11RA SNPs and the clinicopathologic characteristics of PTC. Methods One coding SNP, designated as rs1126757, Ala82Ala, in IL11 and one promoter SNP, designated as rs1061758, −106A/G, in IL11RA were genotyped using direct sequencing in 94 patents with PTC and 213 patients without PTC (controls). Genetic data were analyzed using commercially available software. The patients with PTC were dichotomized and compared with respect to clinicopathologic characteristics of PTC. Results We found an association between PTC and the coding SNP(rs1061758) in IL11RA (codominant model 1 [G/G vs A/G], odds ratio [OR] = 2.91, 95% confidence interval [CI], 1.44–5.89; P = .003; codominant model 2 [G/G vs A/A], OR = 2.95, 95% CI, 1.30–6.72; P = .01; and dominant model, OR = 2.92, 95% CI, 1.47–5.80; P = .002). Moreover, SNP rs1061758 in IL11RA was associated with the multifocality of PTC (codominant model 2 [A/A vs G/G], OR = 9.56, 95% CI, 1.77–51.69; P = .009; and recessive model, OR = 7.22, 95% CI, 1.72–30.3; P = .007). Genotype and allele analyses of SNP variant rs1126757 in IL11 revealed no statistically significant differences between patients with PTC and controls. Conclusion Our results suggest that an IL11RA promoter polymorphism — rs1061758 — may be associated with the risk of PTC in the Korean population. In addition, rs1061758 might be related to the multifocality of PTC.

The incidence of thyroid cancer has been on the increase in a number of countries, and certain genetic factors associated with the increased incidence of the papillary thyroid cancer (PTC) have been identified. However, little is known about the effect of mutations of the cystic fibrosis trans - membrane conductance regulator (CFTR) gene, expressed in the thyroid. We hypothesized and investigated that CFTR single nucleotide polymorphisms (SNPs) may be associated with the risk and/or progression of PTC. A total of 105 PTC patients, confirmed by pathological tests, and 323 controls, without any thyroidal disease, were recruited. One promoter SNP (rs4148682) and one coding SNP (rs213950, Val470Met) in the CFTR gene were analyzed, using direct sequencing. The PTC patients were sub-grouped and compared by their clinical and pathological characteristics of PTC. The results showed that the association between SNPs in the CFTR gene and the development of PTC was statistically insignificant. However, in the clinical and pathological features, rs4148682 was found to be correlated with multifocal tumors, location and cervical node metastasis of PTC. rs231950 was also correlated with multifocal tumors, location and nodal metastasis of PTC. The G allele of rs213950 was correlated with increased risk of multifocal tumors and bilateral lobe location. However, in cervical lymph node metastasis, the A allele of rs213950 was found to reflect high risk. Our study suggests that the CFTR gene polymorphisms studied may not be associated with the development of PTC, but that rs4148682 and rs213950 may be associated with clinical features and prognosis, such as multi- focality, location of cancer and cervical lymph node metastasis of PTC.

Objectives Among the apoptosis signals, B-cell CLL/lymphoma 2 (BCL2) is a well-known regulator of apoptosis with anti-apoptotic properties. We investigated here whether single nucleotide polymorphisms (SNPs) of the BCL2 were associated with host susceptibility of papillary thyroid cancer (PTC) occurrence and clinicopathologic parameters. Methods Ninety-two PTC patients and 222 control subjects were recruited. One promoter SNP (rs2279115, -938A/C) and one synonymous SNP (rs1801018, Thr7Thr) in the BCL2 gene were selected and genotyped using direct sequencing. Multiple logistic regression models were performed to evaluate odds ratios, 95% confidence intervals, and P-values. Results rs1801018 of the BCL2 gene was not associated with the development of PTC. In the clinicopathologic features, rs1801018 SNP was associated with the number and location. The G allele frequency of rs1801018 in PTC patients with multifocality (13.3%) was about four-fold higher than that in PTC patients with unifocality (3.4%). The G allele frequency of rs1801018 in PTC patients with both lobes (15.4%) was increased by about five-fold, compared to PTC patients with one lobe (3.2%). Conclusion The results suggest that synonymous SNP rs1801018 and the G allele of the BCL2 gene may be associated with the multifocality and bilaterality of PTC in Korean population.

Objective. Although topical decongestants and anesthetics are widely used in preparation for nasal endoscopy, no con- trolled trials have evaluated the effects of these agents on olfaction. Study Design. Randomized double-blinded controlled trial. Setting. Tertiary referral hospital. Materials and Methods. The authors recruited 72 healthy subjects and randomly assigned them to 1 of 4 groups (control, phenylephrine group, lidocaine group, and both agents). After baseline tests with the Korean version of Sniffin' Stick Test II (KVSS II), topical agents were applied to each nostril. Fifteen minutes later, repeat tests were car- ried out. Pre- and postspray results of the olfactory tests were compared, and the differences among groups were analyzed. Results. The mean 6 SD prespray KVSS II score of the study group was 30.2 6 3.8, and there were no statistically signifi- cant differences among the study groups (P = .353). Mean 6 SD pre- and postspray KVSS II scores were 29.0 6 3.5 and 30.7 6 3.7 (P = .128) in the control group, 30.6 6 3.6 and 31.7 6 3.3 (P = .262) in the phenylephrine group, and 31.4 6 3.6 and 32.1 6 3.1 (P = .557) in the lidocaine group, respec- tively. In the phenylephrine and epinephrine spray group, the mean 6 SD pre- and postspray scores were 29.9 6 4.4 and 31.3 6 3.7 (P = .071), respectively. Conclusions. Neither topical intranasal phenylephrine nor lidocaine use affected the results of the olfactory test, even when the agents were used in combination.

Objectives. To investigate the changes in gustatory function as a complication after radiofrequency tongue base reduction (RTBR) in patients with obstructive sleep apnea (OSA). Study Design. Before-and-after study. Setting. Academic tertiary medical center. Subjects and Methods. Thirty-four patients with suspected velopharyngeal collapse only underwent uvulopalatopharyngo- plasty (UPPP group). Twenty-five patients with velopharyngeal and retrolingual collapse underwent concurrent UPPP with RTBR (RTBR group). All patients were evaluated before surgery and at 1 and 4 weeks after surgical treatment. A questionnaire was given to assess symptoms of hypogeusia, dysgeusia, hypos- mia, and sensation of the tongue. Electrogustometry (EGM) in 4 areas was used to determine gustatory function. Results. Postoperative values for subjective symptoms did not significantly change following surgical treatment in either group. EGM thresholds of all tested in both groups did not significantly change 1 week and 4 weeks after surgery. Conclusions. Gustatory function remained unchanged after RTBR in patients with OSA. The authors suggest that RTBR is a safe procedure in terms of taste sensation in OSA patients.

Purpose The purpose of this study was to evaluate the efficacy of combined therapy with steroid, carbogen inhalation, and lipoprostaglandin E1 (lipo-PGE1) treatment and compare the results with other treatment modalities in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Subjects and methods The study group consisted of 670 patients diagnosed with unilateral ISSNHL. Two hundred patients (DCP group) were treated with steroid, lipo-PGE1 and carbogen inhalation combination therapy, 194 patients (DC group) with steroid and carbogen inhalation, and 276 patients (D group) with steroid medication only. The therapeutic effects of the treatment groups were evaluated 2 months after treatment, using pure tone averages. Siegel's criteria for hearing improvement were used for the assessments. Results The overall recovery rate after treatment was 57.5%. For each group, the recovery rate was as follows: 67.0% in the DCP group, 52.6% in the DC group, and 53.9% in the D group. The DCP group had a significantly better improvement rate than the other 2 groups. In addition, the DCP treatment was better than the other 2 groups for patients: less than 50 years of age, with an initial hearing loss less than 90 dB HL, had treatment started within 1 week from the onset of hearing loss, had tinnitus or an ascending type audiogram, and/or had no vertigo. Conclusion Steroid, lipo-PGE1, and carbogen inhalation therapy was more effective than the other treatment modalities studied for patients with ISSNHL.

Objective Raf-1 kinase inhibitor protein has potential as a molecular determinant of tumor metastasis and may serve as a prognostic marker. The aim of this study is to analyze the correlation between Raf-1 kinase inhibitor protein expression and the clinicopathologic characteristics of papillary thyroid cancer. Study Design Immunohistochemical analysis. Setting Tertiary care teaching hospital. Subjects and Methods Fifty-nine patients with papillary thyroid cancer underwent total thyroidectomy and central neck dissection. Using specimens from total thyroidectomy and central neck dissection, we performed immunohistochemistry for Raf-1 kinase inhibitor protein and evaluated associations between Raf-1 kinase inhibitor protein expression and lymph node metastasis, tumor size, number of tumors, extrathyroidal invasion, angiolymphatic invasion, and status of the tumor border. Results We found significantly low Raf-1 kinase inhibitor protein expression in papillary thyroid cancer with lymph node metastasis. However, Raf-1 kinase inhibitor protein expression was not associated with tumor size, multifocality, extrathyroidal invasion, or status of the tumor border. Conclusion The loss of Raf-1 kinase inhibitor protein expression is associated with lymph node metastasis of papillary thyroid cancer but not with the progression of primary tumors.

Objective To evaluate the level of immunogloblins and expression of the transcription factors in the adenoids. Methods The study population consisted of 30 children with otitis media with effusion (OME), 22 children with chronic rhinosinusitis (CRS) and 27 children with adenoid hyperplasia. IgA, IgG, IgD and IgM concentrations in these three groups were compared immunohistochemically. We also compared the levels of expression of B lymphocyte inducer of maturation program 1 (BLIMP-1), a promoter of plasmacytosis, and B cell leukemia/lymphoma-6 (BCL-6), a repressor of plasmacytosis, in the adenoids of these children. Results The expression of antibody to Ig A in the OME and CRS groups each was significantly lower than the score in the adenoid hyperplasia group. The staining scores of antibodies to IgG, IgD and Ig M did not differ significantly among the three groups. The expression of antibody to BLIMP-1 in the CRS and adenoid hyperplasia groups showed a significant difference. Staining scores of Antibody to BCL-6 did not differ significantly among the three groups. Conclusions We found that the reduction of IgA in the adenoids was associated with pediatric OME and CRS, and that reduction of expression of the transcription factor BLIMP-1 rather than BCL-6 was associated with CRS.

Background and Objectives: In general, benign neck cysts are treated by surgical excision. This can present technical difficulties and frequent recurrences, because of insufficient surgery. Sclerosing agents such as OK-432 have been tested for the nonsurgical treatment of these cysts. We have assessed the efficacy of OK-432 sclerotherapy for benign neck cysts. Materials and Methods: The study group consisted of 75 patients (42 men, 33 women) diagnosed with and treated for benign neck cysts between March 2001 and December 2007 by intralesional injection of OK-432. The liquid content of each cyst was aspirated as much as possible, and the same volume of OK-432 solution was injected. Patients were assessed by ultrasonography or computerized tomography, and therapeutic outcomes and adverse effects were evaluated by patient age, sex, cyst type, and number of injections. Results: Of the 75 treated patients, 31 (41.3%) showed total shrinkage, seven (9.3%) showed near-total shrinkage (>90% of cyst volume), five (6.6%) showed marked shrinkage (>70% of cyst volume), and 17 (22.7%) showed partial shrinkage (

This study aimed to evaluate the efficacy and safety of single-session radiofrequency tongue base reduction (RTBR) combined with uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea syndrome (OSAS). Sixty-six patients with multilevel obstruction underwent single-session RTBR combined with UPPP. Snoring, Epworth sleepiness scale (ESS) and polysomnography were used to assess outcome before and 6 months after treatment. Sixty-six patients completed this study. Snoring level significantly decreased from 8.0 to 4.3. The mean ESS score significantly decreased from 11.4 to 7.5. The mean apnea-hypopnea index decreased significantly from 22.9 to 13.9. The overall success rate of the single-session RTBR combined with UPPP was 53.6%. Postoperative AHI in 50% of patients was normalized (AHI < 5). The success rates for patients with mild, moderate and severe OSAS were 62.5, 46.2 and 57.1%, respectively. There were two adverse effects, one ulceration of the tongue base and one transient taste change. Single-session RTBR combined with UPPP is an effective and safe treatment for OSAS patients with multilevel obstruction. It could be considered as first treatment for OSAS patients with multilevel obstruction, independent of the severity of OSAS.

Purpose: The pathogenesis of otitis media with effusion (OME) is considered multifactorial, with viral upper respiratory tract infection and eustachian tube dysfunction. Allergy may be related to the pathogenesis of OME or to another etiological factor. We investigated the role of allergic rhinitis (AR) in children with OME and evaluated eustachian tube function in patients with AR. Materials and methods: We prospectively analyzed the prevalence of AR, serum eosinophil count, and serum total IgE concentrations in 123 children with OME and in 141 controls. IgE concentration in middle ear effusion was compared in children with OME with and without AR, and eustachian tube function after a nasal provocation test was compared between patients with AR and controls. Results: The prevalence of AR in children with OME (28.4%) and control subjects (24.1%) did not differ significantly. These 2 groups also showed no differences in total eosinophil count and serum and middle ear effusion IgE concentration. Abnormalities in eustachian tube function were the same in patients with AR and controls. Conclusions: Allergic rhinitis may not be related to the development of OME in children.

To determine salivary pepsin levels as a function of collection time.A prospective, case-control study.We selected 57 patients with clinical symptoms and signs of laryngopharyngeal reflux who underwent 24-hour multichannel intraluminal impedance-pH (24h MII-pH) monitoring tests, and 12 control subjects without clinical symptoms and signs of laryngopharyngeal reflux. All subjects were instructed to collect saliva samples upon waking, 1 hour after each meal (3 times per day), and upon any occurrence of laryngopharyngeal reflux (LPR) symptoms. The pepsin levels in saliva were measured by using enzyme-linked immunosorbent assay. The Reflux Symptom Index survey was also administered.A total of 50 patients in whom LPR was diagnosed based on results of 24h MII-pH monitoring test were enrolled in the study. The average pepsin level upon waking was 17.2 ng/mL, which was significantly higher than that measured in samples collected at any other time (P.005). Pepsin levels were higher in patients with LPR than those in controls. The Reflux Symptom Index scores were statistically different between these groups of subjects.The levels of total pepsin in saliva collected upon waking were significantly higher in the group of patients presenting with LPR symptoms and who demonstrated at least one episode of proximal esophageal reflux during 24h MII-pH monitoring. Furthermore, the average pepsin level upon waking was higher than that measured at any other time. Measuring pepsin levels in the saliva upon waking may be a useful method in the diagnosis of LPR.3b Laryngoscope, 126:2770-2773, 2016.

Endoscope-assisted transoral removal of a thyroglossal duct cyst (TGDC) has been introduced to clinical practice. However, the technical feasibility, efficacy, and safety of this procedure have not been studied. Herein, we conducted a prospective clinical trial to evaluate endoscope-assisted transoral removal of a TGDC.Prospective cohort study.Thirty patients were included. We performed endoscope-assisted transoral removal of TGDCs and evaluated the clinical results and complications over more than 2 years.Endoscope-assisted transoral resection was successful in all cases. However, transient morbidity was noted in one patient. The mean operation time was 67.33 ± 17.26 minutes. Surgery was not required for recurrence or revision during a follow-up.Endoscope-assisted transoral resection of a TGDC is a potentially safe and effective procedure leading to excellent functional and cosmetic outcomes. Additionally, considering the embryological development of TGDCs, the transoral approach can open a new access route to these cysts.2b.

The surgical extent and indication for treatment in patients with papillary thyroid microcarcinoma (PTMC) remain a controversial issue. The aim of this study was to investigate the predictive factor for contralateral occult carcinoma in patients with unilateral PTMC by preoperative ultrasonographic and pathological features.Of the total patients who underwent thyroidectomy, 455 patients with PTMC confined to one unilateral lobe as diagnosed using preoperative ultrasonography (US) were enrolled in the study. Occult contralateral carcinoma was defined as tumor foci in the contralateral lobe that was not detected preoperatively, but was detected pathologically. All patients underwent preoperative US review to investigate the US features of PTMC such as laterality, location, size, internal component, echogenicity, margin, calcification shape, multifocality, bilaterality, extrathyroidal extension, and location with respect to the trachea. Clinicopathological data were also analyzed.Of the total of 455 patients who underwent total thyroidectomy for preoperatively detected unilateral PTMC, 71 patients (15.6 %) had contralateral occult carcinoma. Clinicopathological characteristics did not significantly differ between patients with and without contralateral occult carcinoma. Multivariate analysis showed that the absence of a well-defined margin and the presence of a probably benign nodule in the contralateral lobe were independent predictive factors for contralateral occult carcinoma in patients with unilateral PTMC in preoperative US images.We demonstrated that an absence of a well-defined margin and the presence of a probably benign nodule in the contralateral lobe were independent predictive factors for contralateral occult carcinoma in patients with unilateral PTMC in preoperative US. The prediction of contralateral occult carcinoma in unilateral PTMC using preoperative US features could be useful for determining the optical extent of surgery.

There continues to be a paucity of data regarding the nanostructural changes of vocal fold (VF) collagen after injury. The aim of this study is to investigate the nanostructural and morphological changes in the rabbit VF lamina propria following acute injury using atomic force microscopy (AFM). Unilateral VF injury was performed on 9 New Zealand breeder rabbits. Sacrifice and laryngeal harvest were performed at three time points: 1 day, 3 days, and 7 days after injury. Histology and immunohistochemistry data were collected to confirm extracellular matrix (ECM) changes in rabbit VF. The progressive changes in thickness and D-spacing of VF collagen fibrils were investigated over a 7-day postinjury period using AFM. At post-injury day 1, a fibrin clot and inflammatory cell infiltration were observed at the injured VF. The inflammatory score at postinjury day 1 was highest in injured VF tissue, with a significant decrease at postinjury day 7. The immunoreactivity of inflammatory proteins (COX-2, TNF-α) was observed in VF up to day 7 after injury. AFM investigation showed clustered and disorganized collagen fibrils at the nanoscale resolution at post-injury day 7. Collagen fibrils in injured VF at postinjury day 7 were significantly thicker than control and postinjury days 1 and 3 (P0.001). D-spacing of collagen at postinjury day 7 was not studied due to loss of distinct edges resulting from immature collagen deposition. AFM investigation of VF could add valuable information to understanding micromechanical changes in VF scar tissue.