The impact of second-hand smoke on ear, nose, and throat diseases and head and neck cancers in Japan: a cross-sectional study using a questionnaire and secondary data from the national health and nutrition survey.

BACKGROUND: The risk of head and neck cancers (HNCs) and ear, nose, and throat (ENT) diseases due to second-hand smoke (SHS) have not been fully assessed. OBJECTIVE: To determine which ENT diseases or HNCs are associated with SHS. MATERIAL AND METHODS: Data from a survey of a cross-sectional sample of ENT patients (n = 1228) on SHS exposure were compared to control-subject data (n = 6598) from a Japan National Health Survey. Multivariate logistic regression and estimated odds ratios (ORs) determined whether SHS-disease associations were related to exposure location and disease occurrence. RESULTS: SHS was significantly associated with acute tonsillitis (OR in workplaces, 2.24 [95% CI, 1.34-3.75]; OR in restaurants, 4.24 [95% CI, 2.50-7.19]; OR in leisure places, 4.72 [95% CI, 2.93-7.62]); recurrent tonsillitis (OR in restaurants, 4.24 [95% CI, 2.52-7.13]; OR in leisure places, 5.29 [95% CI, 3.31-8.46]); facial palsy (OR in home, 2.18 [95% CI, 1.25-3.81]; OR in leisure places, 3.41 [95% CI, 1.97-5.89]); hypopharyngeal cancer (OR in home, 2.51 [95% CI, 1.18-5.36]; OR in workplaces, 2.53 [95% CI, 1.24-5.15]); and laryngeal cancer (OR in home, 2.44 [95% CI, 1.04-5.68]; OR in leisure places, 2.25 [95% CI, 1.00-5.07]). CONCLUSIONS AND SIGNIFICANCE: SHS may contribute to HNCs and ENT diseases, suggesting that merely being in the presence of smokers could increase the risk of head and neck morbidities.

Visual effects on the subjective visual vertical and subjective postural head vertical during static roll-tilt.

OBJECTIVES: Tilt perception is part of the perception of spatial orientation. It is determined not only by the allocentric gravity axis, but also by a second allocentric axis induced by visual information as well as by the egocentric body (head) axis induced by somatosensory information. The aim of this study was to quantify roll-tilt perception using the subjective visual vertical (SVV) and the newly developed subjective postural head vertical (SPHV) and to investigate the visual effects on both during static roll-tilt. STUDY DESIGN: Basic science. METHODS: Nine male volunteers participated in this study. A flight simulator was used to create several roll-tilt environments that were then combined with visual information. SVV and SPHV were evaluated in healthy participants during static roll-tilt. RESULTS: The SVV evaluation revealed significant differences between the dark condition (control) and other visual conditions with respect to some of the body roll-tilt environments, and between a body roll-tilt of 0° and ≥ 20°. The SPHV evaluation revealed a significant difference between the dark condition and the visual condition that was always roll-tilted 20° to the right of the body axis. However, there were no significant differences in SPHV error between a body roll-tilt of 0° and other tilt angles for every visual condition, unlike SVV error. CONCLUSIONS: Our data indicate that human susceptibility to spatial disorientation is dependent on roll-tilt angle and visual information. They also suggest that the SPHV is not affected by roll-tilt angle, and thus differs from SVV. LEVEL OF EVIDENCE: NA.

Assessment of hyperacusis with a newly produced Japanese version of the Khalfa hyperacusis questionnaire.

OBJECTIVES: The purpose of this study was to determine the validity and reliability of a Japanese version of the Khalfa hyperacusis questionnaire (KHQ) and proposed a threshold KHQ score for classifying hyperacusis. METHODS: In total, 112 patients with hyperacusis (group A) and 103 patients without hyperacusis (group B). The patients in group A were further classified into the following subgroups: subjects with hyperacusis as their chief complaint (n = 26, group A1) and subjects with hyperacusis accompanied by chief complaints of tinnitus and/or hearing loss (n = 86, group A2). RESULTS: The average total questionnaire score for patients in group A was 11.8 ± 9.7, which was statistically significantly higher than that of patients in group B, 5.7 ± 4.8. Cronbach's coefficients for internal consistency were high for the total score (0.92). The average total scores for groups A1 and A2 were 18.1 ± 11.1 and 9.9 ± 8.4, respectively, and the difference between the groups was statistically significant. CONCLUSIONS: We developed a Japanese version of the KHQ. It showed high reliability and validity; suggesting its usefulness in clinical practice. We propose that a total KHQ score of 16 is an appropriate cutoff for classifying hyperacusis.

A case of nasal septal abscess caused by medication related osteonecrosis in breast cancer patient.

Antiresorptive drugs have been widely used to treat patients with hypercalcemia caused by malignancy, bone metastasis, multiple myeloma, and osteoporosis. However, it is well known that antiresorptive drugs can cause osteonecrosis of the jaw (ONJ). Herein, we report a rare case of nasal septal abscess caused by medication related osteonecrosis of the jaw (MRONJ) in a breast cancer patient. A 69-year-old woman was referred to our clinic for evaluation of nasal obstruction. Physical examination revealed a cherry-like swelling of the nasal mucosa emanating from the septum that obstructed both nasal cavities and a fistulous tract showing pus discharge after extraction of the bilateral maxillary central incisors (MCI) and the right maxillary lateral incisor (MLI). Computed tomography and panoramic radiography revealed extensive osteonecrosis of the maxilla and swelling of the nasal mucosa. The clinical diagnosis was nasal septal abscess caused by osteonecrosis of the maxilla. Surgical procedure was undertaken for this case. An indwelling drain was placed in the oral cavity, and sequestrectomy was performed with incision and drainage of the anterior portion of left nasal septum. The patient was doing well at the 7-month follow-up. The patient had a medical history of breast cancer with bone, lung, liver metastases, and had received intravenous bisphosphonate, which is one of the antiresorptive medicines, over the past 4 years. We suspect that this history played an important role in MRONJ induced nasal septal abscess.

Hemophagocytic syndrome in the course of sudden sensorineural hearing loss.

OBJECTIVE: This paper aims to comprehensively document a rare case of sensorineural hearing loss accompanied by hemophagocytic syndrome which could be one of the causes of cochlear dysfunction. METHODS: A 63-year-old man presented with right-sided sudden hearing loss and dizziness and pure-tone audiometry showed a right-sided sensorineural hearing loss. The patient was treated with steroid pulse infusion therapy, ATP and vitamin B(12). RESULTS: Bone marrow specimen revealed hemophagocytic cells and the diagnosis of hemophagocytic syndrome was made. A blood culture grew Capnocytophaga. The prognosis for hearing recovery was poor. CONCLUSION: Although viral infection and cochlear circulatory dysfunction have been suggested to be associated with sudden sensorineural hearing loss, hemophagocytic syndrome due to bacterial infection which produces high cytokine levels might cause dysfunction of the inner ear.

Diastolic cardiac function is synonymous with long-axis systolic function: a novel concept in cardiac function.

AIMS: There has been recent speculation on the relationship between diastolic cardiac function and long-axis cardiac function. The goal of this study was to obtain conclusive evidence regarding the relationship between these parameters. METHODS: Echocardiography and cardiac magnetic resonance imaging were performed consecutively in 33 subjects. Longitudinal fractional shortening and fractional shortening of the left ventricular wall length were measured in each procedure and the relationships with diastolic cardiac function were assessed. RESULTS: Diastolic cardiac function and long-axis systolic function in each procedure were significantly correlated. Spearman coefficients for correlations between longitudinal fractional shortening measured echocardiographically and diastolic cardiac function parameters were 0.76 (P < 0.0001) for E/A, -0.77 (P < 0.0001) for E/e', 0.87 (P < 0.0001) for e', and 0.91 (P < 0.0001) for e'/a'. CONCLUSIONS: Long-axis cardiac function correlates well with diastolic cardiac function. e'/a' showed a strong correlation with longitudinal fractional shortening and is a good candidate for use as an index for assessment of long-axis cardiac function.

Targeted gene transfer into rat facial muscles by nanosecond pulsed laser-induced stress waves.

We investigate the feasibility of using nanosecond pulsed laser-induced stress waves (LISWs) for gene transfer into rat facial muscles. LISWs are generated by irradiating a black natural rubber disk placed on the target tissue with nanosecond pulsed laser light from the second harmonics (532 nm) of a Q-switched Nd:YAG laser, which is widely used in head and neck surgery and proven to be safe. After injection of plasmid deoxyribose nucleic acid (DNA) coding for Lac Z into rat facial muscles, pulsed laser is used to irradiate the laser target on the skin surface without incision or exposure of muscles. Lac Z expression is detected by X-gal staining of excised rat facial skin and muscles. Strong Lac Z expression is observed seven days after gene transfer, and sustained for up to 14 days. Gene transfer is achieved in facial muscles several millimeters deep from the surface. Gene expression is localized to the tissue exposed to LISWs. No tissue damage from LISWs is observed. LISW is a promising nonviral target gene transfer method because of its high spatial controllability, easy applicability, and minimal invasiveness. Gene transfer using LISW to produce therapeutic proteins such as growth factors could be used to treat nerve injury and paralysis.

Distribution, elimination, and renal effects of single oral doses of europium in rats.

Single doses of europium (III) chloride hexahydrate were orally administered to several groups of rats. Cumulative urine samples were taken at 0-24 h, and blood samples were drawn after 24-h administration. The europium concentration was determined in these samples by inductively coupled plasma atomic emission spectroscopy. The volume, creatinine, ß-2-microglobulin, and N-acetyl-ß-D-glucosaminidase were measured in the urine samples to evaluate possible europium-induced renal effects. The blood samples showed low europium distribution, with an average of 77.5 µg/L for all groups. Although the urinary concentration and excretion showed dose-dependent increases, the percentage of europium excreted showed a dose-dependent decrease, with an average of 0.31% in all groups. The administration of europium resulted in a significant decrease of creatinine and a significant increase of urinary volume, N-acetyl-ß-D-glucosaminidase, and ß-2-microglobulin. Rare earth elements, including europium, are believed to form colloidal conjugates that deposit in the reticuloendothelial system and glomeruli. This specific reaction may contribute to low europium bioavailability and renal function disturbances. Despite low bioavailability, the high performance of the analytical method for determination of europium makes the blood and urine sampling suitable tools for monitoring of exposure to this element. The results presented in this study will be of great importance in future studies on the health impacts of rare earth elements.

Toxicological aspects of cadmium and occupational health activities to prevent workplace exposure in Japan: A narrative review.

Chemicals are an essential part of modern manufacture processes. Their use must be managed with great attention in occupational settings to avoid serious detrimental effects to the health of employees. For example, cadmium compounds are indispensable for the production of nickel-cadmium rechargeable batteries or as chemical stabilizer in plastics. It is an exceptionally toxic heavy metal and personnel exposed to cadmium in the workplace meet with potential health risks that can lead to the development of kidney, skeletal and respiratory disorders. In consequence, proactive and systematical development of occupational hygiene and health activities are necessary to reduce chemical exposure to cadmium in the workplace. This review describes the known facts of cadmium toxicity, the biological effects of cadmium exposure, possible regulation measures to prevent occupational cadmium exposure in three industrial health management systems and discusses future cooperation programs in these systems, proactive safety activities and occupational safety and health management strategies.

Relationship between globus sensation and esophageal clearance.

CONCLUSIONS: Videofluoroscopy (VF) in the prone position can diagnose a range of esophageal pathologies in all age groups. These correlate with globus sensation in younger and middle-aged patients in prone and supine positions. Abnormal esophageal clearance appears to be associated with globus sensation in young and middle-aged persons, but not in the elderly. OBJECTIVES: To assess the correlation between globus sensation and abnormal esophageal clearance by VF in relation to body position and to investigate age-related abnormal esophageal clearance, as well as to confirm the utility of VF in diagnosing globus sensation in patients. SUBJECTS AND METHODS: This was a prospective study. In 72 patients with globus sensation and 33 controls, esophageal clearance was assessed by VF in the upright, supine, and prone positions, and transfer of barium through the esophagus was classified as normal, esophageal retention, esophageal reflux, or pharyngeal reflux. The detection rate of abnormal esophageal clearance was compared among all subjects by age. RESULTS: In the upright position, VF detected no significant differences in the detection rate of abnormal esophageal clearance and reflux between the patients with globus sensation and controls; however, the detection rate of abnormal esophageal clearance was significantly higher in the prone than in the upright and supine positions (p<0.001), and in all positions was significantly higher among globus sensation patients (p<0.05). In the supine and prone positions, there were significantly higher detection rates of abnormal esophageal clearance in patients than in controls in the young group (p<0.05). Additionally in the prone position, there was a significantly higher detection rate of abnormal esophageal clearance and reflux in patients than in controls in the middle-aged group (p<0.05). In all positions, no significant differences were observed in the detection rate of abnormal esophageal clearance and reflux in the patients and controls in the elderly group.

Longitudinal fractional shortening and its relation to diastolic cardiac function.

PURPOSE: Although alterations in longitudinal systolic function have been considered the earliest sign of cardiac damage, the importance of longitudinal fractional shortening (LFS), which reflects left ventricular longitudinal contraction, has not been studied in detail. We introduce a new method of measuring LFS by echocardiography and evaluate its efficiency. METHODS: Our study population consisted of 120 patients with diabetes mellitus (DM), 29 healthy volunteers, and 12 patients with coronary artery disease (CAD). LFS was assessed echocardiographically. Patients with DM underwent conventional echocardiography, assessment of left ventricular diastolic function, and pulsed-wave tissue Doppler study. RESULTS: LFS was 0.07 ± 0.02 in patients with CAD, 0.16 ± 0.05 in patients with DM, and 0.26 ± 0.04 in the normal controls. The three groups differed significantly with respect to the mean LFS values, which were significantly lower in patients with DM than in the normal controls. The ratio of peak diastolic velocities during early filling and atrial contraction (Em/Am) measured on pulsed-wave tissue Doppler images was significantly correlated with LFS (r = 0.37, P < 0.0001). CONCLUSION: LFS is correlated with diastolic cardiac function and is a useful and sensitive index for evaluating long-axis systolic function.

Cholesterol granuloma surrounding the endolymphatic sac.

We report a unique case of cholesterol granuloma (CG) surrounding the endolymphatic sac (ES). A 49-year-old man presented with the left side of sensorineural hearing loss, tinnitus, and vertigo. Magnetic resonance and computed tomography imaging revealed a CG surrounding the left ES. The patient initially underwent left transmastoid surgical resection of the tumor. At the time of surgery, brown fluid was aspirated from the tumor, but no other tumors were found. Histopathological examination revealed that the tumor contained cholesterol crystals, confirming the diagnosis of CG. At his 12-month postoperative follow-up, there was no evidence of recurrence. We discuss the radiology, pathology, and surgical removal of CGs surrounding ES.

[Evaluation of the quality of life in sudden deafness patients by HHIA (hearing Hatidicap Inventory) and questionnaire].

After treatments, several patients with sudden deafness (SD) continued to have symptoms, including hearing loss, tinnitus and dizziness. These unresolved symptoms and their effect on the quality of life (QOL) in SD patients have not been studied. We evaluated QOL using the Hearing handicap inventory (HHIA) and an original questionnaire in SD patients who had been treated more than 6 months prior to the study. Compared to results in bilateral sensorineural hearing were significantly lower in SD patients (p<0.01). In bil SNHL, this score peaked two to 10 years after onset of disease and decreased thereafter. The score peaked more than 10 years after onset of disease in patients with SD. While hearing and test scores were correlated in bil-SNHL, this was not observed in SD. About half of patients were embarrassed by hearing loss and tinnitus after treatment. Among patients who scored more than 44 points on HHIA, all reported hearing loss and tinnitus. When asked about subjective changes in hearing after treatment, 27% believed their hearing had improved, 60% believed there was no change, and 13% believed their hearing had deteriorated. Cases believing deterioration in hearing also had high scores on HHIA. Sequelae of SD may worsen QOL, driving embarrassed patients to visit other medical facilities in to improve their QOL. Even though hearing may not improve after initial treatment in ears affected by SD, informed consent about the clinical course and audiological follow-up should be done.

Construction of a specialized cDNA library from plant cells isolated by laser capture microdissection: toward comprehensive analysis of the genes expressed in the rice phloem.

Laser capture microdissection (LCM) is a powerful system which allows the isolation of selectively targeted cells from a tissue section for the analysis of gene-expression profiles of individual cells. The technique has been successfully used for the isolation of specific mammalian cells, mainly cancer cells. However, LCM has never been reported to be applied to the gene expression analysis of plant cells. We used a modified LCM system and successfully applied it to target and isolate phloem cells of rice leaf tissue whose morphology is apparently different from the surrounding cells. Total RNA was extracted from microdissected (approximately 150) phloem cells and the isolated RNA was used for the construction of a cDNA library following the T7 RNA polymerase amplification. Sequence analysis of 413 randomly chosen clones from the library revealed that there was a high level of redundancy in the population and the clones could be subclassified into 124 different groups that contained related sequences. Approximately 37% of both the redundant population and the non-redundant subgroups had novel components while approximately 63% were either homologues to the known genes reported to be localized in phloem of different plant species, or were homologues to other known genes. In situ hybridization revealed that putative amino acid permease, one of the non-redundant clones, was specifically expressed in the phloem. The results proved the effectiveness of construction of a specialized cDNA library from the specific plant cells.