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Solitary fibrous tumors (SFTs) are spindle-cell tumors that rarely arise within extrathoracic area. Massive SFTs involving the pterygopalatine fossa are extremely rare and surgical excision represents a multidisciplinary surgical challenge. We present a case of 64-year-old female with a huge mass originating from the pterygopalatine fossa invading the skull base. Distinct microscopic findings and a positive nuclear staining of signal transducer and activator of transcription 6 (STAT-6) pathologically confirmed SFT. The right internal maxillary artery branch was embolized preoperatively and a surgical excision was performed through a combined technique of transpalatal, mid-facial degloving and endoscopic approach. Postoperative radiotherapy successfully removed the remnant tumor adjacent to the carvenous sinus. Follow- up MR images showed no evidence of recurrence for two years. To our knowledge, there has been no previous report of the successful treatment of this vast extent of SFT in the pterygopalatine region via endoscopic-external-combined approach and radiotherapy.

Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by elevated parathyroid hormone levels. In most cases, the disease involves a single parathyroid adenoma, followed by parathyroid hyperplasia, but the incidence of ectopic parathyroid adenoma is rare. However, in cases where the parathyroid hormone level remains high even after parathyroid surgery, an ectopic parathyroid gland should be considered. Here in a case of a 60-year-old female who presented PHPT is reported. She had undergone a surgical removal of the parathyroid gland of suspected hyperplasia, but still represented persistent PHPT, postoperatively. Ectopic mediastinal parathyroid adenoma was identified by 99mTc-sestamibi parathyroid scan and surgical excision via a median sternotomy approach was performed. Thirty-eight months postoperatively, there was no evidence of recurrence. Preoperative localization assessment is critical for minimizing surgical failure in cases of PHPT.

Orbital hematic cyst is characterized by cystic accumulation of hematogenous debris surrounded by a wall of fibrous tissue without an epithelial lining. It is a relatively uncommon benign cyst and occurs secondary to blunt trauma in most cases. We experienced a case of 53-year-old male who presented with proptosis of the left eye. A cystic lesion was found at the superolateral orbital rim of the patient. We report a case of orbital hematic cyst that was resected completely through the sub-brow approach.

Background: Drug-induced liver injury (DILI) is a leading cause of drug failure, accounting for nearly 20% of drug withdrawal. Thus, there has been a great demand for in silico DILI prediction models for successful drug discovery. To date, various models have been developed for DILI prediction; however, building an accurate model for practical use in drug discovery remains challenging. Methods: We constructed an ensemble model composed of three high-performance DILI prediction models to utilize the unique advantage of each machine learning algorithm. Results: The ensemble model exhibited high predictive performance, with an area under the curve of 0.88, sensitivity of 0.83, specificity of 0.77, F1-score of 0.82, and accuracy of 0.80. When a test dataset collected from the literature was used to compare the performance of our model with publicly available DILI prediction models, our model achieved an accuracy of 0.77, sensitivity of 0.82, specificity of 0.72, and F1-score of 0.79, which were higher than those of the other DILI prediction models. As many published DILI prediction models are not available for public access, which hinders in silico drug discovery, we made our DILI prediction model publicly accessible (http://ssbio.cau.ac.kr/software/dili/). Conclusion: We expect that our ensemble model may facilitate advancements in drug discovery by providing a highly predictive model and reducing the drug withdrawal rate.

Objectives: Total laryngectomy (TL) patients are good models in which to evaluate the effects of nasal airflow cessation on the sinonasal tract. Here, we evaluated changes in sinonasal structures and association with chronic rhinosinusitis (CRS), in the computed tomography (CT) images three-year post-TL. Design: Retrospective medical chart review. Setting: Tertiary referral medical center, teaching hospital setting. Participants: Data from patients that underwent TL from 2005–2017 were reviewed retrospectively. Patients with a final follow-up CT taken less than 3 years after TL, tracheo-esophageal puncture, inadequate CT image, or history of sinonasal surgery were excluded. The control group included partial laryngectomy or hypopharyngectomy patients. Altogether, 45 TL patients and 38 controls were selected. Main outcome measurements: The volume of all four paranasal sinuses, inferior turbinate mucosal volume (ITMV), maxillary sinus natural ostium (MSNO) mucosal width, and Lund-Mackay scores (LMS) were measured on preoperative and postoperative CT scans. Results: The mean duration between surgery and the final CT scan was 6.3±2.4 and 5.5±2.3 years for the TL and control groups, respectively. Neither group showed significant changes in four paranasal sinuses volume or MSNO mucosa width. The ITMV decreased significantly, from 4.6±1.3ml to 2.8±1.1ml (p

The revolutionary development of artificial intelligence (AI) such as machine learning and deep learning have been one of the most important technology in many parts of industry, and also enhance huge changes in health care. The big data obtained from electrical medical records and digitalized images accelerated the application of AI technologies in medical fields. Machine learning techniques can deal with the complexity of big data which is difficult to apply traditional statistics. Recently, the deep learning techniques including convolutional neural network have been considered as a promising machine learning technique in medical imaging applications. In the era of precision medicine, otolaryngologists need to understand the potentialities, pitfalls and limitations of AI technology, and try to find opportunities to collaborate with data scientists. This article briefly introduce the basic concepts of machine learning and its techniques, and reviewed the current works on machine learning applications in the field of otolaryngology and rhinology.

Sleep surgery is part of a continuum of care for obstructive sleep apnea (OSA) that involves medical, pharmacologic, and behavioral therapy. Upper airway surgery for OSA can significantly improve stability by way of modulating the critical negative closing pressure. This is the same mechanism of action as positive airway pressure or oral appliance therapy. The updated surgical algorithm in this review adds precision in three areas: patient selection, identification of previously unaddressed anatomic phenotypes with associated treatment modality, and improved techniques of previously established procedures. While the original Riley and Powell phase 1 and 2 approach to sleep surgery has focused on individual surgical success rate, this algorithm strives for an overall treatment success with multi-modal and patient-centric treatments.

There are many ways to categorize surgery for obstructive sleep apnea (OSA), one of which is to distinguish between intrapharyngeal and extrapharyngeal procedures. While the general otolaryngologist treating OSA is familiar with intrapharyngeal procedures, such as uvulopalatopharyngoplasty and tongue base reduction, extrapharyngeal sleep operations such as maxillomandibular advancement (MMA) and upper airway stimulation (UAS) have evolved rapidly in the recent decade and deserve a dedicated review. MMA and UAS have both shown predictable high success rates with low morbidity. Each approach has unique strengths and limitations, and for the most complex of OSA patients, the two in combination complement each other. Extrapharyngeal airway operations are critical for achieving favorable outcomes for sleep surgeons.

Distraction osteogenesis maxillary expansion (DOME) is an emerging surgical concept for obstructive sleep apnea patients with a high-arched and narrow hard palate presenting with nasal obstruction. Herein we demonstrate the feasibility of DOME in the treatment of patients with persistent nasal obstruction after primary septoplasty.A total of 32 consecutive patients with persistent nasal obstruction after septoplasty who underwent DOME were enrolled in this study. The efficacy of DOME in treating persistent nasal obstruction in septoplasty failure patients was evaluated using the validated Nasal Obstruction Symptom Evaluation (NOSE) scale. Pre- and postoperative computed tomography (CT) scans were performed to measure the change of nasal floor width after surgery.NOSE score improved significantly from 13.62 ± 4.74 to 5.15 ± 3.50 (p 0.001) after DOME. The postoperative CT scan showed a significant increase of the nasal floor width from 22.4 ± 4.21 to 28.06 ± 4.52 (p 0.01). No patient had major complications such as wound infection, oronasal fistula, sinusitis, loss of incisor teeth, or malunion.We found that DOME appears to improve persistent nasal obstruction after septoplasty in patients with a narrow and high-arched hard palate.

Background: The imaging features of sinonasal extramedullary plasmacytoma (EMP) are non-specific and similar to those of other lesions, such as sinonasal non-Hodgkin’s lymphoma (NHL) and squamous cell carcinoma (SCC). Objectives: To analyze the computed tomography (CT) and magnetic resonance (MR) images of patients with EMP, NHL, and SCC to identify the radiological characteristics differentiating sinonasal EMP from NHL and SCC. Patients and Methods: In this cross-sectional study, the CT and MR imaging features of 37 patients with sinonasal EMP, 46 patients with NHL, and 44 patients with SCC were analyzed. Sinonasal NHL was categorized into two distinct types, namely, natural killer/T-cell lymphoma (n = 32) and diffuse large B-cell lymphoma (n = 14). The tumor volume was determined by measuring the region of interest (ROI) in the picture archiving and communication system (PACS) program. Besides, homogeneity, apparent diffusion coefficient (ADC) in the ADC maps, degree of enhancement, adjacent bone destruction, and invasion to Waldeyer’s ring and cervical or retropharyngeal lymph nodes were evaluated. Results: Although the tumor volume was larger in the EMP group as compared to the NHL and SCC groups, the difference was not statistically significant. The NHL group showed the highest tumor homogeneity on both CT and MR images. EMP was more heterogenous than NHL, with moderate signal intensity on T1-weighted MR images. On the other hand, EMP and NHL showed significantly lower ADCs as compared to SCC. The majority of patients with sinonasal EMP, NHL, and SCC showed an avid enhancement. Also, destructive tumor growth involving the adjacent bone was more frequent in SCC than in EMP or NHL. However, there were no significant differences among sinonasal EMP, NHL, and SCC in terms of invasion to Waldeyer’s ring and cervical or retropharyngeal lymph node metastasis. Conclusion: Marked heterogeneity on T1-weighted images, low ADCs, and lack of adjacent bone destruction were the CT and MR imaging features that favored the diagnosis of EMP over NHL or SCC.

The fate of administered drugs is largely influenced by their metabolism. For example, endogenous enzyme-catalyzed conversion of drugs may result in therapeutic inactivation or activation or may transform the drugs into toxic chemical compounds. This highlights the importance of drug metabolism in drug discovery and development, and accounts for the wide variety of experimental technologies that provide insights into the fate of drugs. In view of the high cost of traditional drug development, a number of computational approaches have been developed for predicting the metabolic fate of drug candidates, allowing for screening of large numbers of chemical compounds and then identifying a small number of promising candidates. In this review, we introduce in silico approaches and tools that have been developed to predict drug metabolism and fate, and assess their potential to facilitate the virtual discovery of promising drug candidates. We also provide a brief description of various recent models for predicting different aspects of enzyme-drug reactions and provide a list of recent in silico tools used for drug metabolism prediction.

BACKGROUND Discrimination of nasal cavity mass lesions is a challenging work requiring extensive experience. A deep learning-based automated diagnostic system may help clinicians to classify nasal cavity mass lesions. We demonstrated the feasibility of a convolutional neural network (CNN)-based diagnosis system for automatic detection and classification of nasal polyps (NP) and inverted papillomas (IP). METHODS We developed a CNN-based algorithm using a transfer learning strategy and trained it on nasal endoscopic images. A total of 99 nasal endoscopic images with normal findings, 98 images with NP, and 100 images with IP were analyzed using the developed CNN. Six otolaryngologists participated in clinical visual assessment. Image-based classification performance was measured by calculating the accuracy and area under the receiver operating characteristic curve (AUC). The diagnostic performance was compared between the CNN and clinical visual assessment by human experts. RESULTS The algorithm achieved an overall accuracy of 0.742 ± 0.058 with the following class accuracies: normal, 0.81± 0.14; IP, 0.57 ± 0.07; and NP, 0.83 ± 0.21. The AUC values for normal, IP, and NP were 0.91 ± 0.06, 0.82 ± 0.09, and 0.84 ± 0.06, respectively. The overall accuracy of the CNN model was comparable with the average performance of human experts (0.742 vs. 0.749; p = 0.11). CONCLUSIONS The trained CNN model appears to reliably classify NP and IP of the nasal cavity from nasal endoscopic images; it also yields a reliable reference for diagnosing nasal cavity mass lesions during nasal endoscopy. However, further studies with more test data are warranted to improve the diagnostic accuracy of our CNN model.

Simple Summary Oligodendrocyte (OD) is a cell type of great interest in the regenerative medicine for several neurological diseases. This study provides a new defined coating material for the differentiation of ODs from human pluripotent stem cells. A new peptide named VNP2, designed by in silico simulation, can be readily produced in a large amount and stably immobilized on the bottom of culture vessel. Upon using for differentiation of ODs, VNP2 promoted the differentiation efficiency more than the conventional coating materials did. Furthermore, transcriptomic analysis revealed molecular clues for the differentiation promoting activity of VNP2. Therefore, this peptide may be used as a favored coating material for the culture and differentiation of ODs. Abstract Differentiation of oligodendrocytes (ODs) presents a challenge in regenerative medicine due to their role in various neurological diseases associated with dysmyelination and demyelination. Here, we designed a peptide derived from vitronectin (VN) using in silico docking simulation and examined its use as a synthetic substrate to support the differentiation of ODs derived from human pluripotent stem cells. The designed peptide, named VNP2, promoted OD differentiation induced by the overexpression of SOX10 in OD precursor cells compared with Matrigel and full-length VN. ODs differentiated on VNP2 exhibited greater contact with axon-mimicking nanofibers than those differentiated on Matrigel. Transcriptomic analysis revealed that the genes associated with morphogenesis, cytoskeleton remodeling, and OD differentiation were upregulated in cells grown on VNP2 compared with cells grown on Matrigel. This new synthetic VN-derived peptide can be used to develop a culture environment for efficient OD differentiation.

Motivation Identification of blood–brain barrier (BBB) permeability of a compound is a major challenge in neurotherapeutic drug discovery. Conventional approaches for BBB permeability measurement are expensive, time-consuming and labor-intensive. BBB permeability is associated with diverse chemical properties of compounds. However, BBB permeability prediction models have been developed using small datasets and limited features, which are usually not practical due to their low coverage of chemical diversity of compounds. Aim of this study is to develop a BBB permeability prediction model using a large dataset for practical applications. This model can be used for facilitated compound screening in the early stage of brain drug discovery. Results A dataset of 7162 compounds with BBB permeability (5453 BBB+ and 1709 BBB-) was compiled from the literature, where BBB+ and BBB- denote BBB-permeable and non-permeable compounds, respectively. We trained a machine learning model based on Light Gradient Boosting Machine (LightGBM) algorithm and achieved an overall accuracy of 89%, an area under the curve (AUC) of 0.93, specificity of 0.77 and sensitivity of 0.93, when 10-fold cross-validation was performed. The model was further evaluated using 74 central nerve system compounds (39 BBB+ and 35 BBB-) obtained from the literature and showed an accuracy of 90%, sensitivity of 0.85 and specificity of 0.94. Our model outperforms over existing BBB permeability prediction models. Availabilityand implementation The prediction server is available at http://ssbio.cau.ac.kr/software/bbb.

Adenoid cystic carcinoma is one of the most common minor salivary gland malignancies of the head and neck region. However, adenoid cystic carcinoma of the nasal septum is extremely rare. The authors herein report a case of a septal adenoid cystic carcinoma in a 68-year-old man who complained of nasal bleeding and nasal obstruction for several months. Diagnostic nasal endoscopy revealed a protruding mass arising from the anterosuperior part of the nasal septum. The tumor was removed with a safety margin using the open rhinoplasty approach and primary reconstruction of the surgical defect was performed using septal cartilage. Histopathology indicated an adenoid cystic carcinoma with cribriform pattern. Two years postoperatively, there was no evidence of recurrence, the functional and cosmetic results were good, and the patient was satisfied with the treatment outcome.

Background Use of absorbable packing materials after functional endoscopic sinus surgery (FESS) is associated with increased patient comfort and a lack of need for packing removal. Different materials may induce different patterns of mucosal healing and hemostasis. This study investigated the effect of fibrin sealant (FS; Tisseel) or biodegradable synthetic polyurethane foam (Nasopore®) packing on hemostasis and wound healing after FESS. Methods This prospective randomized controlled trial included 35 consecutive patients who underwent bilateral FESS for chronic rhinosinusitis. The patients were randomized to receive FS through aerosol spraying on 1 side and Nasopore packing on the opposite side. They were followed at 1, 2, 4, 8, and 12 weeks after surgery. Endoscopically visible packing material, crusting, adhesion, bleeding, granulation tissue formation, frontal sinus patency, and adverse effects were assessed. Subjective symptoms related to nasal packing were evaluated by using questionnaires quantified with a visual analogue scale. Results No significant differences were found between the FS-treated side and the Nasopore-packed side with respect to postoperative bleeding, adhesion, or frontal sinus patency. However, crusting and granulation were significantly lower in FS-treated nostrils (p < 0.01). The patients’ satisfaction and willingness to reuse the material were not significantly different between FS and Nasopore. There were no allergic reactions to either material. Conclusion FS and Nasopore were equally successful in achieving hemostasis and patient satisfaction after FESS. However, our results suggest that differential mucosal healing patterns may be induced by alternative absorbable hemostatic materials. FS-treated sides showed more optimal healing patterns than Nasopore-packed sides.

DNA transformation that delivers plasmid DNAs into bacterial cells is fundamental in genetic manipulation to engineer and study bacteria. Developed transformation methods to date are optimized to specific bacterial species for high efficiency. Thus, there is always a demand for simple and species-independent transformation methods. We herein describe the development of a chemico-physical transformation method that combines a rubidium chloride (RbCl)-based chemical method and sepiolite-based physical method, and report its use for the simple and efficient delivery of DNA into various bacterial species. Using this method, the best transformation efficiency for Escherichia coli DH5α was 4.3×106CFU/μg of pUC19 plasmid, which is higher than or comparable to the reported transformation efficiencies to date. This method also allowed the introduction of plasmid DNAs into Bacillus subtilis (5.7×103CFU/μg of pSEVA3b67Rb), Bacillus megaterium (2.5×103CFU/μg of pSPAsp-hp), Lactococcus lactis subsp. lactis (1.0×102CFU/μg of pTRKH3-ermGFP), and Lactococcus lactis subsp. cremoris (2.2×102CFU/μg of pMSP3535VA). Remarkably, even when the conventional chemical and physical methods failed to generate transformed cells in Bacillus sp. and Enterococcus faecalis, E. malodoratus and E. mundtii, our combined method showed a significant transformation efficiency (2.4×104, 4.5×102, 2×101, and 0.5×101CFU/μg of plasmid DNA). Based on our results, we anticipate that our simple and efficient transformation method should prove usefulness for introducing DNA into various bacterial species without complicated optimization of parameters affecting DNA entry into the cell.

Background/objective The aim of this study was to evaluate the usefulness of simultaneous middle and inferior meatal antrostomies (SMIAs) as a treatment modality in patients with maxillary fungal sinusitis and to compare the efficacy of SMIA with that of conventional middle meatal antrostomy (MMA). Methods A retrospective study was performed on consecutive patients with noninvasive fungal maxillary sinusitis. Twenty-one patients underwent endoscopic sinus surgery with SMIA group and the remaining 24 patients were treated with the conventional MMA group. Medical records were reviewed for history, clinical presentation, radiographic findings, surgical intervention, complications, and outcomes. Outcomes consisted of the visual analog scale (VAS) for the main symptoms and maxillary sinus endoscopic scores. The stenosis or obstruction of the antrostomy site and postoperative mucociliary function was also evaluated. Results VAS scores for facial pain and nasal discharge/postnasal drip were significantly improved in the SMIA group. The maxillary endoscopic score was also significantly reduced in the SMIA group. There were no significant differences between 2 groups with respect to the preoperative Lund–Mackay score, VAS score of nasal obstruction, nasal bleeding, postoperative mucociliary function, and MMA patency. Conclusions The SMIA technique is useful for identifying and removing fungal debris that cannot be reached through the MMA and could bring better surgical outcomes.

Drug candidates often cause an unwanted blockage of the potassium ion channel of the human ether-a-go-go-related gene (hERG). The blockage leads to long QT syndrome (LQTS), which is a severe life-threatening cardiac side effect. Therefore, a virtual screening method to predict drug-induced hERG-related cardiotoxicity could facilitate drug discovery by filtering out toxic drug candidates. In this study, we generated a reliable hERG-related cardiotoxicity dataset composed of 2130 compounds, which were carried out under constant conditions. Based on our dataset, we developed a computational hERG-related cardiotoxicity prediction model. The neural network model achieved an area under the receiver operating characteristic curve (AUC) of 0.764, with an accuracy of 90.1%, a Matthews correlation coefficient (MCC) of 0.368, a sensitivity of 0.321, and a specificity of 0.967, when ten-fold cross-validation was performed. The model was further evaluated using ten drug compounds tested on guinea pigs and showed an accuracy of 80.0%, an MCC of 0.655, a sensitivity of 0.600, and a specificity of 1.000, which were better than the performances of existing hERG-toxicity prediction models. The neural network model can predict hERG-related cardiotoxicity of chemical compounds with a high accuracy. Therefore, the model can be applied to virtual high-throughput screening for drug candidates that do not cause cardiotoxicity. The prediction tool is available as a web-tool at http://ssbio.cau.ac.kr/CardPred .

Objective To evaluate the risk of cardio-cerebrovascular disease (CCVD), such as ischemic stroke and acute myocardial infarction (AMI), in patients diagnosed with Bell palsy STUDY DESIGN: Population-based follow-up study. Methods We used the National Sample Cohort 2002 to 2013 data from the Korea National Health Insurance Service. The Bell palsy group comprised all patients diagnosed with Bell palsy (n = 730). The comparison group comprised patients selected randomly using propensity score matching (n = 1,460). The Kaplan-Meier survival analysis, log-rank test, and Cox proportional-hazards regression models were used to calculate the disease-free survival rate and hazard ratio (HR) of CCVD for each group. Results Of the total study population, ischemic stroke developed in 15.7% of patients with Bell palsy and 9% of patients in the comparison group during the 12-year follow-up period. After adjusting for other factors, the HR of ischemic stroke during the 12-year follow-up period was 1.84 times greater in the Bell palsy group than in the comparison group (95% confidence interval [CI], 1.43-2.36). However, the adjusted HR of developing ischemic stroke for patients with Bell palsy treated concurrently with antiviral agents and steroids was 1.12 (95% CI, 0.62.-2.04). There was no significant relationship between Bell palsy and risk of AMI development (HR, 1.13; 95% CI, 0.71-1.82). Conclusion Bell palsy is linked with an increased incidence of ischemic stroke. Our data suggest that Bell palsy may be used as an indicator of increased stroke risk, and concurrent treatment with antiviral agents and steroids may be effective in preventing ischemic stroke. Level of evidence NA Laryngoscope, 129:2371-2377, 2019.

Background Administered drugs are often converted into an ineffective or activated form by enzymes in our body. Conventional in silico prediction approaches focused on therapeutically important enzymes such as CYP450. However, there are more than thousands of different cellular enzymes that potentially convert administered drug into other forms. Result We developed an in silico model to predict which of human enzymes including metabolic enzymes as well as CYP450 family can catalyze a given chemical compound. The prediction is based on the chemical and physical similarity between known enzyme substrates and a query chemical compound. Our in silico model was developed using multiple linear regression and the model showed high performance (AUC = 0.896) despite of the large number of enzymes. When evaluated on a test dataset, it also showed significantly high performance (AUC = 0.746). Interestingly, evaluation with literature data showed that our model can be used to predict not only enzymatic reactions but also drug conversion and enzyme inhibition. Conclusion Our model was able to predict enzymatic reactions of a query molecule with a high accuracy. This may foster to discover new metabolic routes and to accelerate the computational development of drug candidates by enabling the prediction of the potential conversion of administered drugs into active or inactive forms.

Background and Objective Radiofrequency (RF) turbinoplasty may be effective in treating nonallergic rhinitis in elderly patients. The present study evaluated the efficacy of nasal turbinate surgery with RF for the treatment of nonallergic rhinitis in elderly patients refractory to medical therapy. Methods A total of 35 consecutive patients older than 65 years of age (mean subject age, 75.5 ± 9.6 [standard deviation] years) with nonallergic rhinitis refractory to medical therapy who underwent RF turbinate surgery were enrolled in this study. The efficacy of RF turbinoplasty in treating nonallergic rhinitis in elderly patients was evaluated by using rhinoscopy and a visual analog scale score of nasal symptoms. Results The response rate of primary RF turbinate surgery for nonallergic rhinitis refractory to medical therapy was 68.6%. Postoperative symptom scores for rhinorrhea and nasal obstruction were significantly improved. Persistent crust formation developed in seven patients (20.0%). No patient experienced major complications (e.g., septal hematoma, abscess, septal perforation), but partial bone necrosis was observed in one patient. Conclusion RF turbinoplasty appeared to be effective for treating some nonallergic rhinitis symptoms in elderly patients, including rhinorrhea and nasal obstruction. These preliminary results are encouraging and warrant further investigation.

Crushed cartilage grafts are used to conceal irregularities and achieve a smoother nasal surface. They can potentially be stabilized by a fibrin sealant acting as a carrier. The primary purpose of this study was to assess the clinical outcome of crushed cartilage-fibrin sealant combination grafts for radix augmentation performed in Asian patients.This study included 51 patients (38 men and 13 women) who underwent rhinoplasty with radix augmentation using crushed cartilage grafts. The malleable construct used for radix augmentation contained autologous crushed cartilage grafts stabilized with a fibrin sealant. Preoperative and postoperative photographs were reviewed for objective and subjective assessment of aesthetic outcomes. The mean follow-up period was 18.5 months (range, 12 to 25 months).Preoperative and postoperative objective measurements indicated that the mean increment of the radix projection was 28.5 ± 7.9 percent and that of the nasofrontal angle was 11.5 ± 3.8 degrees. Most patients showed prominent radix augmentation and good cosmetic results. Postoperative aesthetic outcomes were graded as excellent in 41.2 percent of cases, good in 37.3 percent, fair in 15.7 percent, and unchanged/poor in 5.9 percent. Complications included one case (2.0 percent) of partial graft resorption and two cases (3.9 percent) of graft visibility.The results show that the use of a crushed cartilage-fibrin sealant graft is a reliable and effective technique of stabilizing grafts for radix augmentation in Asian patients.Therapeutic, IV.

Objective Septal body hypertrophy, like inferior turbinate hypertrophy, can result in changes to the nasal cross-sectional area and resistance to airflow. The aim of this study is to evaluate the efficacy of septal body volume reduction (SBVR) for the treatment of septal body hypertrophy in patients with nasal obstruction. Study Design Prospective randomized study. Methods The study was conducted on two groups (51 patients) with symptoms and signs of nasal obstruction associated with septal body and inferior turbinate hypertrophy that were refractory to medical therapy. In the turbinoplasty only (ITR) group (n = 25), conventional turbinoplasty was only performed on the inferior turbinate. In the septal body reduction (SBR) group (n = 26), concurrent bilateral microdebrider-assisted SBVR was performed during the turbinate surgery. Results The nasal symptoms, including nasal obstruction, rhinorrhea, itching, and sneezing, had significantly improved at 3 months after treatment in both groups (P

Chronic rhinosinusitis (CRS) is a highly prevalent disease characterized by mucosal inflammation of the nose and paranasal sinuses. CRS can be divided into two main categories, CRS with nasal polyps (NPs; CRSwNP) and CRS without NPs (CRSsNP). Although the pathophysiology of CRS remains unclear, DNA methylation has been implicated in the etiology of CRSwNP. The aim of the present study was to elucidate whether DNA methylation of specific genes is involved in the development of NPs. In total, 18 individuals were included in the present study, and were divided into three groups: CRSwNP (n=7), CRSsNP (n=7) and healthy controls (n=4). NP tissues were obtained from the seven patients with CRSwNP and biopsies of the inferior turbinate mucosa from all three groups were used as controls. Methylated genes detected by methyl‑CpG‑binding domain sequencing were validated by methylation‑specific polymerase chain reaction (PCR), bisulfite sequencing, and reverse transcription‑quantitative PCR (RT‑qPCR). Methyl‑CpG‑binding domain sequencing identified 43,674 CpG islands in 518 genes. The promotor regions of 10 and 30 genes were hypermethylated and hypomethylated, respectively, in NP samples compared with controls. The top four genes with altered hypomethylation in NP tissues were, Keratin 19 (KRT19), nuclear receptor subfamily 2 group F member 2 (NR2F2), A Disintegrin‑like And Metallopeptidase (Reprolysin Type) with Thrombospondin type 1 motif 1 (ADAMTS1) and zinc finger protein 222 (ZNF222). RT‑qPCR demonstrated that the expression levels of KRT19, NR2F2 and ADAMTS1 were significantly increased in NP tissues; however, there was no difference in the levels of ZNF222 between NP and control tissues. Further studies are required to confirm the relevance of these epigenetic modifications in the mechanisms underlying NP formation.

Background The purpose of this study was to investigate the effect of aerosolized fibrin sealant (FS) compared with that of polyvinyl acetal sponge packing on hemostasis and wound healing after functional endoscopic sinus surgery (FESS). Methods We conducted a prospective randomized controlled trial of the use of aerosolized FS in 41 consecutive patients who underwent bilateral FESS between February 2011 and March 2012. The patients were randomized to receive FS applied via an aerosol spray in one nasal cavity and polyvinyl acetal sponge packing in the opposite cavity. The patients were followed up at 1, 2, 4, 8, and 12 weeks postoperatively. Crusting, adhesion, bleeding, granulation tissue formation, infection, and frontal sinus ostium stenosis after endoscopic surgery were assessed using a grading scale. Subjective symptoms related to nasal packing were evaluated using questionnaires quantified by visual analog scales. Results The degree of granulation and crusting was significantly reduced in the side treated with FS compared with the polyvinyl acetal sponge side, as were bleeding and pain during nasal packing removal (p < 0.05). In addition, general satisfaction and willingness to reuse the material were significantly higher for the FS-treated side than for the polyvinyl acetal sponge-packed side (p < 0.001). Conclusions Compared with polyvinyl acetal sponge, aerosolized FS shows beneficial effects on hemostasis and wound healing after FESS. The application of FS resulted in a high degree of patient satisfaction without additional morbidity.

Importance Chronic rhinosinusitis (CRS) is associated with a decreased quality of life, affecting physical and emotional aspects of daily function, the latter of which could manifest as depression and anxiety. Objective To evaluate the risk of depression and anxiety in CRS, depending on the CRS phenotype (CRS without nasal polyps [CRSsNP] and CRS with nasal polyps [CRSwNP]). Design, Setting, and Participants This retrospective nationwide cohort study used population-based insurance data (consisting of data from approximately 1 million patients). The study population included 16 224 patients with CRS and 32 448 individuals without CRS, with propensity score matching between groups according to sociodemographic factors and enrollment year. Data were collected from January 1, 2002, through December 31, 2013, and analyzed from July 1 through November 15, 2018. Main Outcomes and Measures Survival analysis, the log-rank test, and Cox proportional hazards regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of depression and anxiety for each group. Results Among the 48 672 individuals included in the study population (58.8% female), the overall incidence of depression during the 11-year follow-up was 1.51-fold higher in the CRS group than in the non-CRS group (24.2 vs 16.0 per 1000 person-years; adjusted HR, 1.54; 95% CI, 1.48-1.61). The incidence of anxiety was also higher in the CRS group than in the comparison group (42.2 vs 27.8 per 1000 person-years; adjusted HR, 1.57; 95% CI, 1.52-1.62). Moreover, the adjusted HRs of developing depression (CRSsNP, 1.61 [95% CI, 1.54-1.69]; CRSwNP, 1.41 [95% CI, 1.32-1.50]) and anxiety (CRSsNP, 1.63 [95% CI, 1.57-1.69]; CRSwNP, 1.45 [95% CI, 1.38-1.52]) were greater in patients with CRSsNP than in those with CRSwNP. Conclusions and Relevance This observational study suggests that CRS is associated with an increased incidence of depression and anxiety. Specifically, findings from this study found that patients without nasal polyps showed a higher risk of developing depression and anxiety than those with nasal polyps.

Low-concentration hypochlorous acid (HOCl) is an endogenous antibacterial and antiviral agent. The purpose of this study was to evaluate the effectiveness of HOCl irrigation in patients with chronic rhinosinusitis (CRS) refractory to medical therapy. Forty-three adult patients (mean age 45.5 years) were enrolled in this study. They were randomly chosen to receive nasal irrigation with either low-concentration HOCl generated by a Salicid device (n = 21), or a placebo (saline; n = 22) for 8 weeks. The outcome measures were scores on the 20-Item SinoNasal Outcome Test (SNOT-20), rhinosinusitis disability index (RSDI), nasal endoscopic score, and bacterial cultures. The SNOT-20 scores were significantly lower in the HOCl group than in the placebo group after 2 weeks of treatment (p 0.05) and remained lower after 4 weeks of treatment. With respect to the RSDI scores, there was a significant improvement in the HOCl group at 1 week after treatment and in both groups at 2 weeks after treatment (p 0.05). There were no significant differences in the endoscopic scores between the two groups after the treatment. The bacterial culture rates were lower in the HOCl group than in the placebo group after 4 weeks of treatment, but this was not significant (p 0.05). Our results showed that low-concentration HOCl irrigation resulted in a greater improvement in CRS symptoms as compared to saline irrigation.

Radiofrequency surgery was introduced to minimize thermal damage to the tissue. A radiofrequency electrode can be used to make cuts in the free edge of the soft palate like those done in laser-assisted uvulopalatoplasty [radiofrequency-assisted uvulopalatoplasty (RAUP)]. Tonsillectomy can enlarge the lateral diameter of the pharynx. The aim of our study was to evaluate the efficacy of RAUP with tonsillectomy in treatment of obstructive sleep apnea syndrome (OSAS). Ninety-two patients with obstructive sleep apnea were included in this study. Patients were categorized according to disease severity and Friedman's staging system. Patients were assessed with the preoperative visual analog scale (VAS) for snoring, Epworth Sleepiness Scale (ESS) and apnea-hypopnea index (AHI) at baseline and repeated at 6 months postoperatively. The intensity of postoperative pain, speech deficits and dysphagia were also recorded. There was a significant improvement in the VAS score for snoring, ESS and AHI before and after surgery. Overall, the results of the present study indicated a surgery success rate (a 50 % decrease in AHI and AHI