Effectiveness and Safety of Acupotomy Treatment on Shoulder Pain: 25 Multicenter Retrospective Study.

Objective: Shoulder pain is a common complaint in outpatient clinics and can result in an inability to work or perform household activities, leading to significant socioeconomic burden. Acupotomy, as one kind acupuncture that has flat knife-shaped tip, has been widely used for treating shoulder pain. However, despite the widespread use of acupotomy in primary medical institutions, large sample size clinical trials have not sufficiently been performed. In this respect, this multi-center retrospective study aimed to investigate the effectiveness and safety of acupotomy in reducing shoulder pain and disability using data from multi-center primary care clinics. Methods: This study was conducted in 25 Korean medicine clinics affiliated with the Korean Medical Society of Acupotomology, Republic of Korea, from August 2021 to December 2021. The medical records of patients who visited the clinics complaining of shoulder pain were gathered, and among them were those of patients who underwent acupotomy treatment and those who received acupuncture combined therapy. The Numeric Rating Scale (NRS), SPADI (Shoulder Pain and Disability Index), Range of Motion (ROM) and adverse event were evaluated at each visit. A linear mixed-effects models and paired t-test were used to identify the effectiveness of the treatment. Results: Overall analysis showed that the NRS score of patients decreased from 4.95 ± 1.97 before treatment to 3.78 ± 2.03 after treatment (n = 332, difference in NRS score, 1.17; 95% CI: 0.96-1.38, t = 10.89 p < 0.001). SPADI score decreased from 19.05 ± 20.44 at baseline before treatment to 12.12 ± 17.26 after the last visit, which was statistically significant (n = 332, mean difference in SPADI score, 6.93; 95% CI: 4.71-9.15, t = 6.150, p < 0.001). No serious adverse event was reported in both groups. Conclusion: This study showed the effectiveness of acupotomy therapy for shoulder pain, and as the treatment sessions increased, the effect of pain reduction and shoulder function improvement were also increased.

An Observational Study Using Ultrasound to Assess Allowable Needle Insertion Range of Acupoint CV12.

BACKGROUND: Abdominal organ injuries are a rarely reported complication when deep acupuncture needling is applied to the abdomen. In order to ascertain the allowable needle insertion range (ANIR) of the abdomen region, we selected acupoint CV12, which is commonly used for treating gastric disease, and ANIR was measured with an ultrasound device. METHOD: Eighty-five healthy volunteers were recruited, of which 83 cases of ultrasound images were obtained. To investigate the prediction factor of ANIR, we also measured several anthropometric factors. RESULTS: The average ANIR was 25.3 ± 10.2; generally, the ANIRs of females were thicker than those of males; and the liver was observed in 62.7% subjects' ultrasound images. The non-observed group showed thicker ANIR and higher BMI than the liver-observed group. CONCLUSION: There are reliable variables that make it possible to predict the ANIR. It is advised to refer to anthropometric factors in needling acupoint CV12 to avoid complications with the acupuncture treatment. However, individual differences are not negligible when applying deep needling. Thus, if the risk is not judged before or during the procedure, practitioners could consider the patient's ANIR on CV12 when applying acupuncture by examining the individual anatomical structures using ultrasound and considering internal organ positions to prevent adverse events due to acupuncture.

Assessment of Korean rice lines for their reaction to rice yellow mottle virus in Ghana.

Rice yellow mottle virus (RYMV) is the most damaging viral disease of rice in Africa and can cause yield losses of up to 100%. The objective of this study was to characterize newly introduced rice lines from Korea into Ghana for their reaction to RYMV infection. One hundred and seventy-two rice lines from Korea were screened for their level of resistance RYMV in a screen house at Fumesua, Ghana. Four checks consisting of two highly resistant lines (Tog7291 and Gigante with rymv1-2 (resistant gene1-allele2) and rymv2 (resistant gene2) respectively), a moderately resistant line (CRI-Amankwatia) and a susceptible cultivar Jasmine 85 were used. The experiment was carried out in a 4 x 44 lattice design with four replicates. Screening for RYMV resistance was conducted by visual symptom scoring and virus-assessment through serology using enzyme linked immunosorbent assay (ELISA) test. Disease incidence and severity were assessed from 2 to 42 dpi. Data for disease severity and incidence were transformed (Log x+1) for ANOVA. Five lines (8261112, 8261119, 8261133, 8261588, and 8261634) were identified to be highly resistant to the disease just like Tog7291 and Gigante. The study also revealed 24 lines that were resistant but not grouping with Tog7291 and Gigante, whereas 100 moderately resistant lines clustered with the moderately resistance check CRI-Amankwatia in a distinct group. Forty-three (43) susceptible lines were identified with the susceptible check Jasmine 85 falling in this group. No highly susceptible line was identified. The newly idenfied resistant genotypes can be used by breeders to develop RYMV resistant varieties.

Multiscale Modeling Reveals the Cause of Surface Stress Change on Microcantilevers Due to Alkanethiol SAM Adsorption.

Experimental results show that the adsorption of the self-assembled monolayers (SAMs) on a gold surface induces surface stress change that causes deformation of the underlying substrate. However, the exact mechanism of stress development is yet to be elucidated. In the present study, multiscale computational models based on molecular dynamics (MD) simulations are applied to study the mechanism governing surface stress change. Distinct mechanisms for adsorption-induced surface deformation, namely, interchain repulsion and thiol-gold interaction-driven gold surface reconstruction, are investigated. Two different interatomic potentials, embedded atom method and surface-embedded atom method (SEAM), are used in the MD simulations to study the reconstruction-induced surface stresses. Comparison of the predicted surface stress changes, resulting from MD and continuum mechanics-based models, with the observed experimental response indicates that a modified SEAM-based multiscale model can better capture the surface stress changes observed during alkanethiol SAM formation, and gold surface reconstruction is the primary factor behind the surface stress change. The interchain repulsions of SAM are found to have a minimal contribution. Also, both the simulations and experiments show that the surface stress change increases with the increase of surface coverage density and larger grain size.

Electrochemical Properties of HA Coated Titanium Dioxide Nanotubes.

CP Grade II titanium was first anodized in order to form TiO2 nanotubes, and then the TiO2 nano- tubes were coated with hydroxyapatite using the sol-gel method. The electrochemical properties of pure Ti, anodized TiO2 nanotubes, and HA-coated TiO2 nanotubes were investigated using poten- tiodynamic polarization and impedance tests. The sol-gel-coated HA nanoparticles were observed to sufficiently penetrate into the TiO2 nanotubes, and the polarization resistance of the HA-coated titanium nanotubes was higher than that of those that had just been anodized. In conclusion, the HA coating on the TiO2 nanotubes provides improved electrochemical properties and can be effective in overcoming the negative influence of passive TiO2 films.

Effect of Viscosities on the Surface Morphology and Crystallographic Properties of Hydroxyapatite Coated Titanium Dioxide Nanotubes.

Hydroxyapatite (HA) coating on biomaterials is crucial for bone growth. TiO2 naotubes having a larger specific area can also improve an osseointegration. In this study, anodized TiO2 nanotubes were coated with HA using sol-gel method with different viscosities of solution. Morphological characterization and crystal structures of the coated specimens were measured via field emission scanning electron microscope, transmission electron microscope, X-ray diffractometer, and fourier transforrm infrared spectroscopy. Nanosized hydroxyapatite particles were observed with sol viscosities at 1.95 cP and 0.94 cP inside the TiO2 nanotubes. When coated with the lower viscosity of solution, the TiO2 nanotubes were clearly observed. The crystallinity of HA increased as the temperature of heat treatment increased. The HA phase on the specimen was identified by PO4(3-) and OH-ion peaks in FT-IR spectra.

Agronomic and genetic analysis of Suweon 542, a rice floury mutant line suitable for dry milling.

BACKGROUND: Producing rice flour of good quality by dry milling is necessary to reduce milling costs and promote the processed rice food industry. This study was conducted to evaluate the dry milling properties of Suweon 542, a floury endosperm mutant, and identify the chromosomal region responsible for the floury endosperm characteristics. RESULTS: Compared with the wild type, after dry milling process, the grain hardness of Suweon 542 was significantly lower because of its round and loosely packed starch granules. Also, the flour of Suweon 542 had significantly smaller particles and less damaged starch than Namil and other rice cultivars and its particle size distribution was similar to a commercial wheat cultivar. Considering that the yield loss of Suweon 542 due to its floury endosperm was largely compensated for by an increased number of spikelets per panicle, Suweon 542 has potential value as a raw material for rice flour production. Association analysis using 70 genome-wide SSR markers and 94 F2 plants derived from Suweon 542/Milyang 23 showed that markers on chromosome 5 explained a large portion of the variation in floury grains percentage (FGP). Further analysis with an increased number of SSR markers revealed that the floury endosperm of Suweon 542 was directed by a major recessive locus, flo7(t), located in the 19.33-19.86 Mbp region of chromosome 5, with RM18639 explaining 92.2% of FGP variation in the F2 population. CONCLUSIONS: The floury endosperm of Suweon 542 is suitable for dry milling, with a small flour particle size and low damaged starch content. Further physical mapping of flo7(t), the floury endosperm locus of Suweon 542, would facilitate efficient breeding of rice cultivars with proper dry milling adaptability that can be used in the processed rice food industry.

Histomorphological factors in the risk prediction of lymph node metastasis in papillary thyroid carcinoma.

AIMS: Few clinicopathological parameters have been identified as independent predictive factors for lymph node metastasis. This study evaluated the predictive ability of three histological characteristics of PTC in lymph node metastases: hobnail features, loss of cohesiveness/polarity (LOCP) and micropapillary structures. METHODS AND RESULTS: Tissue specimens from 153 patients with histologically confirmed PTC including 112 cases of papillary thyroid microcarcinoma (PTMC) were enrolled in this study. Three histological characteristics (hobnail features, LOCP and micropapillary structures) and several clinicopathological parameters were evaluated for their value in predicting lymph node metastasis. Hobnail features, LOCP and micropapillary structures were each significantly associated with and found to be independent predictive factors for lymph node metastasis (P < 0.05). These three histological characteristics were closely correlated with one another (P < 0.001). Six of the seven possible combinations of these three histological characteristics were independently correlated with lymph node metastasis (P < 0.05). Among these combinations, the coincidence of all three histological parameters represented the strongest independent predictive factor for lymph node metastasis (OR: 3.270, P = 0.006). CONCLUSIONS: Our study demonstrates that hobnail features, LOCP and micropapillary structures, either alone or in combinations, represent strong independent predictive factors for lymph node metastasis in PTC.

An RNA aptamer-based microcantilever sensor to detect the inflammatory marker, mouse lipocalin-2.

Lipocalin-2 (Lcn2) is a biomarker for many inflammatory-based diseases, including acute kidney injury, cardiovascular stress, diabetes, and various cancers. Inflammatory transitions occur rapidly in kidney and cardiovascular disease, for which an in-line monitor could be beneficial. Microcantilever devices with aptamers as recognition elements can be effective and rapidly responsive sensors. Here, we have selected and characterized an RNA aptamer that specifically binds mouse Lcn2 (mLcn2) with a dissociation constant of 340 ± 70 nM in solution and 38 ± 22 nM when immobilized on a surface. The higher apparent affinity of the immobilized aptamer may result from its effective multivalency that decreases the off-rate. The aptamer competes with a catechol iron-siderophore, the natural ligand of mLcn2. This and the results of studies with mLcn2 mutants demonstrate that the aptamer binds to the siderophore binding pocket of the protein. A differential interferometer-based microcantilever sensor was developed with the aptamer as the recognition element in which the differential response between two adjacent cantilevers (a sensing/reference pair) is utilized to detect the binding between mLcn2 and the aptamer, ensuring that sensor response is independent of environmental influences, distance between sensing surface and detector and nonspecific binding. The system showed a detection limit of 4 nM. This novel microcantilever aptasensor has potential for development as an in-line monitoring system for mLcn2 in studies of animal models of acute diseases such as kidney and cardiac failure.

Oral muscle relaxant may induce immediate allergic reactions.

Eperisone and afloqualone act by relaxing both skeletal and vascular smooth muscles to improve circulation and suppress pain reflex. These drugs are typically prescribed with non-steroidal anti-inflammatory drugs (NSAIDs) as painkillers. However, there have been no reports on serious adverse reactions to oral muscle relaxants; and this is the first report to describe three allergic reactions caused by eperisone and afloqualone. All three patients had histories of allergic reactions after oral intake of multiple painkillers, including oral muscle relaxants and NSAIDs, for chronic muscle pain. An open-label oral challenge test was performed with each drug to confirm which drugs caused the systemic reactions. All patients experienced the same reactions within one hour after oral intake of eperisone or afloqualone. The severity of these reactions ranged from laryngeal edema to hypotension. To confirm that the systemic reaction was caused by eperisone or afloqualone, skin prick testing and intradermal skin tests were performed with eperisone or afloqualone extract in vivo, and basophil activity tests were performed after stimulation with these drugs in vitro. In one patient with laryngeal edema, the intradermal test with afloqualone extract had a positive result, and CD63 expression levels on basophils increased in a dose-dependent manner by stimulation with afloqualone. We report three allergic reactions caused by oral muscle relaxants that might be mediated by non-immunoglobulin E-mediated responses. Since oral muscle relaxants such as eperisone and afloqualone are commonly prescribed for chronic muscle pain and can induce severe allergic reactions, we should prescribe them carefully.

Aptamer functionalized microcantilever sensors for cocaine detection.

A cocaine-specific aptamer was used as a receptor molecule in a microcantilever-based surface stress sensor for detection of cocaine molecules. An interferometric technique that relies on measuring differential displacement between two microcantilevers (a sensing/reference pair) was utilized to measure the cocaine/aptamer binding induced surface stress changes. Sensing experiments were performed for different concentrations of cocaine from 25 to 500 µM in order to determine the sensor response as a function of cocaine concentration. In the lower concentration range from 25 to 100 µM, surface stress values increased proportionally to coverage of aptamer/cocaine complexes from 11 to 26 mN/m. However, as the cocaine concentration was increased beyond 100 µM, the surface stress values demonstrated a weaker dependence on the affinity complex surface coverage. On the basis of a sensitivity of 3 mN/m for the surface stress measurement, the lowest detectable threshold for the cocaine concentration is estimated to be 5 µM. Sensing cantilevers could be regenerated and reused because of reversible thermal denaturation of aptamer.

Design of a Pep-1 peptide-modified liposomal nanocarrier system for intracellular drug delivery: Conformational characterization and cellular uptake evaluation.

In order to facilitate the intracellular delivery of macromolecules, Pep-1 peptide-modified liposomal (Pep1-Lipo) nanocarriers were designed and examined for their in vitro cell translocation capability. Pep-1 peptides were coupled via thiol-maleimide linkage to small unilamellar vesicles composed of phosphatidylcholine, Tween 80, and N-[4-(p-maleimidophenyl)butyryl]-phosphatidylethanolamine (MPB-PE). The amount of Pep-1 peptide conjugated to the vesicle was effectively controlled by the amounts of maleimide groups on the vesicular surface, ranging from 70 to 700 molecules per vesicle. Systems were evaluated for cell uptake capacity by monitoring entrapped fluorescence-labeled bevacizumab, a model protein for poorly permeable macromolecule, using confocal microscopy. The novel carriers rapidly bound to the cell membrane and migrated into the cells within 1 h, exhibiting better translocation of macromolecules compared to that of conventional liposomes. Cellular uptake of Pep1-Lipo was proportional to the amount of Pep-1 peptide on the liposomal surface. In conclusion, we found that the Pep1-Lipo formulation was a promising nanocarrier system for intracellular delivery of macromolecules.

Increase in serum haptoglobin and apolipoprotein M in patients with obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) is a common syndrome, which is associated with a number of medical problems that impact morbidity and mortality. Although the precise mechanisms that underlie these associations are not fully understood, previous studies have suggested that patients with OSA show elevations of several biomarkers that are associated with cardiovascular risk. This study was undertaken to identify serum proteins associated with OSA by using a proteomics technique and to examine changes in identified protein levels after continuous positive airway pressure treatment. The study participants consisted of 40 male patients (aged 40-49 years) with severe OSA and 34 male control subjects matched for age and body mass index. All subjects underwent polysomnography. Using a proteomics approach, we identified nine proteins that were differentially expressed in patients with severe OSA and controls. Three of these nine proteins, haptoglobin, paraoxonase-1 and apolipoprotein M, were quantified by using enzyme-linked immunosorbent assays, kinetic assays and by using Western blotting. Multiple regression analysis showed that haptoglobin and apolipoprotein M levels are independently related to apnoea-hypopnoea index (P < 0.01). A further study is required to determine the nature of associations between these identified proteins and OSA in a large population.

Aspiration pneumonia due to polyethylene glycol-electrolyte solution (Golytely) treated by bronchoalveolar lavage.

Polyethylene glycol (PEG)-electrolyte solution (Golytely), is most commonly used for bowel preparation before colonoscopy, as well as for barium enema and colon surgery. In this case, a 70-year-old man developed ARDS following the administration of Golytely by mouth before a scheduled colonoscopy. Aspiration of PEG-electrolyte solution was suspected, and the patient was successfully treated by BAL. Therefore, early bronchoscopy and BAL should be considered as initial treatment for PEG aspiration, because removal of PEG is most important for managing the disease.

Association of snoring with chronic bronchitis.

BACKGROUND: Snoring is more prevalent in patients with chronic bronchitis than in persons without it. Few studies have examined the effect of snoring on chronic bronchitis. We prospectively investigated the association between snoring and the incidence of chronic bronchitis. METHODS: The baseline study was conducted from June 25, 2001, to January 29, 2003. Members of the study cohort consisted of 5015 male and female Korean citizens aged 40 to 69 years at baseline who participated in a comprehensive health examination and on-site interviews at Korea University Ansan Hospital. Of these, 4270 participants (52% men and 48% women) entered the analysis for the first 2-year follow-up from April 17, 2003, to February 20, 2005, and those who met the same inclusion criteria remained in the analysis for a second 2-year follow-up period from February 21, 2005, to November 17, 2006. We collected information on snoring at baseline and identified incident cases of chronic bronchitis during a 4-year follow-up period. On the baseline questionnaire, we excluded participants who reported the presence of cough and sputum production on most days for at least 3 months a year. RESULTS: During 4 years of follow-up, we documented 314 cases of new-onset chronic bronchitis (27.1 cases per 1000 person-years). After taking into account age, smoking, and other risk factors for chronic bronchitis, the multivariate relative risks of chronic bronchitis were 1.25 (95% confidence interval [CI], 0.95-1.64) for persons snoring 5 times per week or less and 1.68 (95% CI, 1.17-2.42) for those snoring 6 to 7 times per week compared with never snorers (P for trend = .049). The analyses stratified by risk factors, including smoking, occupation, and body mass index, showed a stronger association among never smokers, house workers, and overweight persons. In analysis for the joint effect of smoking and snoring, the relative risks of chronic bronchitis were 1.39 (95% CI, 1.01-1.90) for nonsmoking and snoring, 2.31 (95% CI, 1.38-3.87) for smoking and never snoring, and 2.86 (95% CI, 1.91-4.27) for smoking and snoring compared with nonsmoking and never snoring. CONCLUSIONS: This prospective study observed that snoring is associated with chronic bronchitis. Our findings provide support for the hypothesis that snoring influences the development of chronic bronchitis.

Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy.

BACKGROUND: Endoscopic techniques have recently been applied to thyroid surgery. We developed the bilateral axillo-breast (BAB) approach for total thyroidectomy. The aims of this study were to evaluate the completeness of this approach for total thyroidectomy and to compare complications between endoscopic thyroidectomy and conventional open thyroidectomy. METHODS: We analyzed 198 patients who underwent open thyroidectomy and 103 patients who underwent endoscopic thyroidectomy for papillary thyroid microcarcinoma between January 2003 and June 2006 at Seoul National University Hospital. The postoperative thyroglobulin (TG) level was used to assess the completeness of the two methods. Complications such as hypocalcemia or vocal cord palsy were also evaluated. RESULTS: The mean hospitalization period was 3.18 days following open thyroidectomy and 3.04 days after endoscopic thyroidectomy. The 3-month postoperative TG levels were <1.0 ng/ml in 90.4% of patients after open total thyroidectomy and in 88.9% following endoscopic total thyroidectomy. Transient hypocalcemia occurred in 17.7% and 25.2% of patients, respectively. Permanent hypocalcemia occurred in 4.5% and 1.0% of patients, respectively. Permanent vocal cord palsy frequencies were 0.5% and 0%, respectively. There were no significant differences in postoperative TG levels, hypocalcemia, or permanent vocal cord palsy. Transient vocal cord palsy occurred in 2.5% of patients after open thyroidectomy and in 25.2% after endoscopic thyroidectomy (p < 0.0001), but it disappeared within 3 months. Cosmetic results were excellent after endoscopic thyroidectomy. CONCLUSIONS: The bilateral axillo-breast (BAB) approach for endoscopic thyroidectomy shows insignificant postoperative complications, except transient vocal cord palsy, as well as good cosmetic results. It is also a feasible method for total thyroidectomy. Therefore, the BAB approach for endoscopic total thyroidectomy can be the surgical treatment of choice for selected cases of thyroid cancer.

Biological imaging of HEK293 cells expressing PLCgamma1 using surface-enhanced Raman microscopy.

Surface-enhanced Raman scattering (SERS) imaging has been used for the targeting and imaging of specific cancer markers in live cells. For this purpose, Au/Ag core-shell nanoparticles, conjugated with monoclonal antibodies, were prepared. The procedures to label live cells with those bimetallic nanoprobes have been developed and used for highly sensitive SERS imaging of live cells. In the present study, live HEK293 cells expressing PLCgamma1 have been used as the optical imaging target. Our results demonstrate the potential feasibility of SERS imaging technology for the highly sensitive imaging of cancer biomarkers in live cells.

Association of habitual snoring with glucose and insulin metabolism in nonobese Korean adult men.

Habitual snoring is associated with cardiovascular morbidity and mortality, and metabolic abnormalities such as impaired glucose homeostasis. Many studies were performed in obese Western populations. The purpose of this study was to examine the association of habitual snoring with glucose and insulin metabolism in nonobese Korean men who were free of diabetes and hypertension. A total of 2,719 men ages 40-69 years from the Korean Health and Genome Study participated in this study. Information of snoring frequency was obtained by a questionnaire and glucose and insulin levels during oral glucose tolerance test were measured. Repeated measures analysis of variance detected significant differences in the changing patterns of glucose and insulin levels at 1 hour and 2 hours between habitual snorers and nonhabitual snorers, whereas there were no significant differences in fasting blood glucose and insulin levels. Multivariate logistic regression analyses revealed that habitual snoring was independently associated with elevated 1-hour and 2-hour glucose levels and a 2-hour insulin level, respectively. The present data suggest that habitual snoring may affect glucose-insulin metabolism, independent of diabetes and hypertension, even in nonobese Korean middle-age men. Further prospective studies are needed to examine the causal relationship between habitual snoring and insulin resistance or glucose intolerance.

Prevalence of sleep-disordered breathing in middle-aged Korean men and women.

With many epidemiologic studies made to establish the prevalence of sleep-disordered breathing (SDB) and obstructive sleep apnea syndrome (OSAS) in Western countries, no such data have been reported in Korea. The purpose of this study was to examine the prevalence of SDB and OSAS, and their related factors in Korean adults aged 40-69 years. Among the total of 5,020 participants at the baseline examination of the Korean Health and Genome Study, a random sample of 457 men and women was studied with employment of overnight full polysomnography to determine the prevalence of SDB and OSAS. The prevalence of SDB (apnea-hypopnea index > or = 5) was 27% and 16% in men and women, respectively. When OSAS was defined by an apnea-hypopnea index > or = 5 plus excessive daytime sleepiness, its prevalence was 4.5% in men and 3.2% in women. Logistic regression analyses showed that sex, body mass index, and hypertension were closely associated with the risk of SDB. Our findings show that SDB is a common problem in the Korean adult population. Understanding and treatment of SDB may be essential in terms of intervention to reduce the risk of related medical problems.

Relation of epidermal growth factor receptor expression to mucus hypersecretion in diffuse panbronchiolitis.

STUDY OBJECT: Diffuse panbronchiolitis (DPB) is a hypersecretory airway disease, and the mechanism of mucus hypersecretion in DPB is poorly understood. Moreover, mucin synthesis in the airways has been reported to be regulated by neutrophilic inflammation-induced epidermal growth factor receptor (EGFR) expression, and the degranulation of goblet cells is known to be mediated by neutrophilic elastase. In this study, we examined the relationship between EGFR expression in the bronchiolar epithelium with neutrophilic inflammation and mucus hypersecretion in the tissues of DPB patients. DESIGN: The tissue specimens of 13 DPB patients and 6 healthy control subjects were examined by alcian blue/periodic acid-Schiff (AB/PAS) staining for mucous glycoconjugates, and by immunohistochemical staining for MUC5AC, EGFR, tumor necrosis factor-alpha, and CD16 on neutrophils. RESULTS: Neutrophilic inflammation was significantly higher in the tissue of DPB patients than in that of control subjects (p = 0.002). In the bronchiolar epithelium, goblet cell metaplasia, by AB/PAS staining and mucin MUC5AC expression, was significantly higher than that in control subjects (p = 0.001 and p = 0.002, respectively). In addition, the morphometric quantification of intraluminal mucus secretion showed that the areas of the bronchiolar lumen occupied by mucus secretion were significantly increased in the tissue of DPB patients (p = 0.001), suggesting goblet cell degranulation. EGFR expression was observed in the bronchiolar epithelium of DPB patients, but not in that of control subjects. CONCLUSIONS: In DPB, we suggest that mucus hypersecretion due to goblet cell metaplasia is closely associated with neutrophilic inflammation and the expression of EGFR. The study also shows that intraluminal secretion due to the degranulation of goblet cells degranulation is related to neutrophilic inflammation.