1,721,000 research outputs found
Inhibition of allergic response by intranasal selective NF-κB decoy oligodeoxynucleotides in a murine model of allergic rhinitis
No full textPurpose: It remains unknown whether local inhibition of Nuclear factor-kappa B (NF-kappa B) could have therapeutic value in the treatment of allergic rhinitis (AR). This study aimed to evaluate the effect of selective NF-kappa B inhibition using NF-kappa B decoy oligodeoxynucleotides (ODNs) for the local treatment of AR in ovalbumin (OVA)-sensitized wild-type mice. Methods: BALB/c mice were sensitized with OVA and alum, and then challenged intranasally with OVA. NF-kappa B decoy ODNs were given intranasally to the treatment group, and NF-kappa B scrambled ODNs were given to the sham treatment group. Allergic symptom scores, eosinophil infiltration, cytokine levels in the nasal mucosa, nasal lavage fluid, and spleen cell culture, serum total and OVA-specific immunoglobulins, as well as intercellular adhesion molecure-1 (ICAM-1) in the nasal mucosa, were analyzed. Results: NF-kappa B decoy ODNs significantly reduced allergic symptoms and eosinophil infiltration in the nasal mucosa. They also suppressed serum levels of total IgE, OVA-specific IgE, and IgG1. IL-5 and TNE-alpha levels and the expression of ICAM-1 were decreased in the nasal mucosa of the treatment group compared to the positive control and sham treatment groups. In addition, IL-6 levels were significantly decreased in the nasal lavage fluid of the treatment group. Furthermore, NF-kappa B decoy ODNs significantly reduced expression of the systemic Th2 cytokines, IL-4 and IL-5 in spleen cell culture. Conclusions: This study demonstrates for the first time that local NF-kappa B inhibition using NF-kappa B decoy ODNs suppressed the allergic response in a murine AR model. This shows the therapeutic potential of local NF-kappa B inhibition in the control of AR.N
Intrapatient Comparison of Coblation versus Electrocautery Tonsillectomy in Children: A Randomized, Controlled Trial
No full textMany surgical instruments have been introduced and compared for safety and surgical efficiency in tonsillectomy. This study aimed to compare postoperative pain between coblation and conventional monopolar electrocautery tonsillectomy by intrapatient comparison in children. Thirty pediatric patients over six years of age undergoing tonsillectomies were enrolled. Coblation and electrocautery were used to remove both tonsils in one patient; one was removed by coblation and the other by electrocautery. The coblation side was randomly selected, and it was blinded to the patients. Each side’s daily pain scores were collected on the visual analogue scale (VAS) during ten postoperative days. On the day of surgery, 22 (73%) patients identified less pain on the coblation side, while others felt similar pain. The mean pain scores were significantly lower on the coblation side during the postoperative ten days (except for the 6th and 8th) than on the electrocautery side. The duration of severe pain (VAS > 5) was significantly shorter on the coblation side than on the electrocautery side (2.0 versus 3.7 days, respectively; p = 0.042). Coblation tonsillectomy induced less pain than electrocautery in pediatric patients; therefore, surgeons could choose the coblator as a surgical instrument for tonsillectomy to improve the pediatric postoperative quality of life
Evaluating Prediction Models of Sleep Apnea From Smartphone-Recorded Sleep Breathing Sounds
No full text© 2022 American Medical Association. All rights reserved.Importance: Breathing sounds during sleep are an important characteristic feature of obstructive sleep apnea (OSA) and have been regarded as a potential biomarker. Breathing sounds during sleep can be easily recorded using a microphone, which is found in most smartphone devices. Therefore, it may be easy to implement an evaluation tool for prescreening purposes. Objective: To evaluate OSA prediction models using smartphone-recorded sounds and identify optimal settings with regard to noise processing and sound feature selection. Design, Setting, and Participants: A cross-sectional study was performed among patients who visited the sleep center of Seoul National University Bundang Hospital for snoring or sleep apnea from August 2015 to August 2019. Audio recordings during sleep were performed using a smartphone during routine, full-night, in-laboratory polysomnography. Using a random forest algorithm, binary classifications were separately conducted for 3 different threshold criteria according to an apnea hypopnea index (AHI) threshold of 5, 15, or 30 events/h. Four regression models were created according to noise reduction and feature selection from the input sound to predict actual AHI: (1) noise reduction without feature selection, (2) noise reduction with feature selection, (3) neither noise reduction nor feature selection, and (4) feature selection without noise reduction. Clinical and polysomnographic parameters that may have been associated with errors were assessed. Data were analyzed from September 2019 to September 2020. Main Outcomes and Measures: Accuracy of OSA prediction models. Results: A total of 423 patients (mean [SD] age, 48.1 [12.8] years; 356 [84.1%] male) were analyzed. Data were split into training (n = 256 [60.5%]) and test data sets (n = 167 [39.5%]). Accuracies were 88.2%, 82.3%, and 81.7%, and the areas under curve were 0.90, 0.89, and 0.90 for an AHI threshold of 5, 15, and 30 events/h, respectively. In the regression analysis, using recorded sounds that had not been denoised and had only selected attributes resulted in the highest correlation coefficient (r = 0.78; 95% CI, 0.69-0.88). The AHI (β = 0.33; 95% CI, 0.24-0.42) and sleep efficiency (β = -0.20; 95% CI, -0.35 to -0.05) were found to be associated with estimation error. Conclusions and Relevance: In this cross-sectional study, recorded sleep breathing sounds using a smartphone were used to create reasonably accurate OSA prediction models. Future research should focus on real-life recordings using various smartphone devices..N
Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea
No full text© 2022, The Author(s).Background: Excessive collapse of the soft palate and lateral pharyngeal wall narrowing are established causes of loud snoring and sleep apnea in subjects with obstructive sleep apnea (OSA). Therefore, delicate surgical techniques are needed to reshape the soft palate and create sufficient tension in the lateral pharyngeal wall. This study aimed to determine the therapeutic outcome and favorable indications of soft-palate webbing flap pharyngoplasty in subjects with OSA and primary snoring. Methods: A total of 174 subjects who underwent soft-palate webbing flap pharyngoplasty combined with uvulopalatal flap and septoturbinoplasty from August 2015 to February 2020 were included in this study. Medical records, including pre- and postoperative sleep parameters, were retrospectively reviewed. The primary outcome measure was the degree of improvement in AHI after surgery. Other outcomes were differences in surgical response rates, subjective visual analog score (VAS) for snoring, sleep quality, and complications. Results: Polysomnographic results showed that apnea–hypopnea index (AHI) scores were significantly reduced from 39.6 ± 6.1 to 22.9 ± 3.6 following soft-palate webbing flap pharyngoplasty in 59 subjects, and overall success and response rates of this technique were analyzed with 71%. We found that the successful outcomes were observed in 50% of mild (n = 12) and 56% of moderate (n = 16) subjects with OSA subjects due to lateral pharyngeal wall collapse. The success rate of soft-palate webbing flap pharyngoplasty was relatively higher in subjects with mild and moderate OSA than those with severe OSA. Additionally, the mean VAS snoring scale was 4.7 and subjects primary snoring intensity significantly improved to 2.9 after soft-palate webbing flap pharyngoplasty. Subjective symptoms such as daytime sleepiness and sleep quality also showed improvement. Most complications were found to be minimal and improved by 1 month after the operation. Conclusion: Our data demonstrate that soft-palate webbing flap pharyngoplasty is an effective treatment for OSA and primary snoring and may be a promising technique to reduce lateral pharyngeal wall collapse.N
Predictive markers for neoadjuvant chemotherapy in advanced squamous cell carcinoma of maxillary sinus: Preliminary report
No full textConclusion: ERCC 1 seems to be promising as a predictive marker for response to neoadjuvant chemotherapy (NAC) and early decision for surgery in advanced squamous cell carcinoma (SCC) of the maxillary sinus. Objectives: This study aimed to find a possible relation of ERCC1 or XRCC1 expression with response to NAC and prognosis in advanced SCC of the maxillary sinus. Methods: From 1998 to 2006, 17 patients with advanced SCC of the maxillary sinus received NAC at the Seoul National University Hospital. The expression of ERCC1 and XRCC1 was assessed by immunohistochemistry. Complete and partial remissions were categorized as the chemo-sensitive group. On the other hand, stable and progressive diseases were categorized as the chemo-resistant group. Results: Of these 17 patients, 1 had complete remission, 6 had partial remission, 4 had stable disease, and 6 had progression of disease. The 5-year survival rate was 40% for all 17 patients. The expression of ERCC1 and XRCC1 was not correlated with nodal or distant metastasis. With a cut-off value of 65%, patients with higher ERCC1 scores showed chemo-resistance and survival disadvantage over those with lower ERCC1 scores. However, XRCC1 did not show a significant effect on the response to NAC.N
Adenotonsillar hypertrophy as a risk factor of dentofacial abnormality in Korean children
No full textNo studies for the role of adenotonsillar hypertrophy in development of dentofacial abnormalities have been performed in Asian pediatric population. Thus, we aimed to investigate the relationship between adenotonsillar hypertrophy and dentofacial abnormalities in Korean children. The present study included consecutive children who visited a pediatric clinic for sleep-disordered breathing due to habitual mouth breathing, snoring or sleep apnea. Their palatine tonsils and adenoids were graded by oropharyngeal endoscopy and lateral cephalometry. Anterior open bite, posterior crossbite, and Angle's class malocclusions were evaluated for dentofacial abnormality. The receiver-operating characteristic curve analysis was used to identify age cutoffs to predict dentofacial abnormality. A total of 1,083 children were included. The presence of adenotonsillar hypertrophy was significantly correlated with the prevalence of dentofacial abnormality [adjusted odds ratio = 4.587, 95 % CI (2.747-7.658)] after adjusting age, sex, body mass index, allergy, and Korean version of obstructive sleep apnea-18 score. The cutoff age associated with dentofacial abnormality was 5.5 years (sensitivity = 75.5 %, specificity = 67 %) in the children with adenotonsillar hypertrophy and 6.5 years (sensitivity = 70.6 %, specificity = 57 %) in those without adenotonsillar hypertrophy. In conclusion, adenotonsillar hypertrophy may be a risk factor for dentofacial abnormalities in Korean children and early surgical intervention could be considered with regards to dentofacial abnormality.N
The Effect of Positional Dependency on Outcomes of Treatment With a Mandibular Advancement Device
No full textObjective: To evaluate retrospectively the efficacy of the mandibular advancement device (MAD) in patients with obstructive sleep apnea in terms of positional dependency. Design: Retrospective analysis. Setting: Academic tertiary referral center. Patients: One hundred patients with obstructive sleep apnea treated with the MAD at the Department of Otorhinolaryngology sleep clinic were included from January 1, 2005, through December 31, 2010. Interventions: All patients underwent nocturnal full-night polysomnography before and at least 3 months after intraoral MAD application. Main Outcome Measures: Treatment results and prognostic factors deciding the success of MAD application. Results: Of the 100 patients, 80 showed positional dependency and 20 showed nondependency. In the position-dependent obstructive sleep apnea group, the median (interquartile range) apnea-hypopnea index (AHI) decreased from 32.1 (24.4-41.9) to 8.6 (3.7-13.8) (P<.001); in the nondependent group, from 56.4 (26.2-71.5) to 15.7 (6.8-30.7) (P<.001). The success rate (AHI reduction >= 50% and AHI <10) was 57.5% and 30.0% in position-dependent and position-nondependent groups, respectively (P=.04). Conclusion: Identifying patients with obstructive sleep apnea as position dependent or nondependent may have important therapeutic implications in predicting the outcome of MAD treatment.N
Cardiopulmonary coupling analysis: changes before and after treatment with a mandibular advancement device
No full textThe aim of this study is to evaluate the changes of sleep quality in patients using a mandibular advancement device (MAD) for obstructive sleep apnea (OSA) based upon cardiopulmonary coupling (CPC). A total of 52 patients (mean age 53.7 +/- 9.6 years, range 33-74 years) were included in this study. Of them, there were 47 males (90.4 %). All subjects were diagnosed with OSA after in-laboratory full-night polysomnography and reevaluated after 3-month use of a MAD. At baseline, apnea-hypopnea index (AHI) was 33.6 +/- 17.0, Epworth sleepiness scale was 10.5 +/- 4.8, and Pittsburgh sleep quality index was 5.8 +/- 2.8. The CPC parameters were extracted from single-lead electrocardiography of polysomnography. We compared CPC parameters at baseline with those after 3-month use of a MAD. All respiratory indices improved with the use of MAD. However, there were no differences in the sleep architectures except N3 sleep (3.7 +/- 4.3 to 6.9 +/- 6.4 %, p < 0.001). The CPC parameters showed a significant improvement with the use of MAD. Low-frequency coupling (59.5 +/- 16.1 to 47.7 +/- 14.8 %, p < 0.001) and elevated low-frequency coupling (44.6 +/- 18.4 to 32.6 +/- 15.7 %, p < 0.001) significantly decreased. High-frequency coupling (28.6 +/- 16.0 to 36.5 +/- 15.7 %, p = 0.004) and very low frequency coupling (11.7 +/- 7.2 to 15.3 +/- 6.6 %, p = 0.028) significantly increased. The change of AHI significantly correlated with changes of the CPC parameters: negatively correlated with high-frequency coupling change (r = -0.572, p < 0.001) and positively correlated with low-frequency and elevated low-frequency coupling changes (r = 0.604 and 0.497, respectively; p < 0.001 in both). However, the changes of Epworth sleepiness scale and Pittsburgh sleep quality index after MAD therapy showed no significant correlation with the changes in the CPC parameters. To our knowledge, this is the first study to evaluate the quality of sleep in patients using a MAD for their OSA based upon CPC analysis. Low-frequency coupling decreased as AHI improved, while high-frequency coupling increased as AHI improved. The CPC parameters showed that the sleep quality was improved by MAD therapy.N
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