Prospective randomized clinical trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics.

PURPOSE: Antibiotics are widely used in the treatment of uncomplicated left-sided colonic diverticulitis. In Asian countries, however, right-sided colonic diverticulitis is more common than left-sided colonic diverticulitis. The aim of the present study was to evaluate the need for antibiotics in the treatment of uncomplicated right-sided colonic diverticulitis in an Asian population. METHODS: Patients were randomized to two management strategies: antibiotics and no antibiotics. At 4-6 weeks after discharge, the patients in both groups underwent computed tomography or were contacted by phone to confirm the effectiveness of the treatment. The primary end point was the treatment failure rate of the initial treatment, and secondary end points were the length of hospital stay and total admission costs. RESULTS: Patients were randomized to treatment with (61 patients) or without (64 patients) antibiotics. The rates of treatment failure in the antibiotics and no antibiotics groups were 1.7% and 4.6%, respectively, with no significant difference (P = 0.619). There was also no significant difference in the length of hospital stay between the groups (P = 0.983). Total admission costs were lower in the no antibiotics group than in the antibiotics group (US$1004.70 vs US$1112.40, respectively, P = 0.037). CONCLUSION: Conservative management of uncomplicated right-sided colonic diverticulitis without antibiotics shows similar treatment failure rates and length of hospital stay, and is associated with lower hospital costs, compared with standard antibiotic treatment. Therefore, conservative management can be considered as a safe treatment option. TRIAL REGISTRATION: ClinicalTrial.gov No. NCT02314013.

Omission of axillary surgery in cN0, postmenopausal ER-positive/HER2-negative breast cancer patients undergoing breast-conserving treatment.

Background: Previous clinical trials have diminished the significance of lymph node (LN) metastasis and axillary surgery in breast cancer, particularly in cN0, postmenopausal estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative patients undergoing breast-conserving treatment (BCT). We assessed the replacement of axillary surgery with preoperative imaging modalities by analyzing the proportion of high nodal burden (HNB) patients with ≥3 LN metastases in these patients. Methods: We retrospectively identified 333 cN0, postmenopausal ER-positive/HER2-negative breast cancer patients who underwent BCT in two hospitals between January 2003 and December 2017. The proportion of LN metastasis patients and the number of metastatic LN were investigated. Risk factors of LN metastasis were analyzed and recurrence-free survival (RFS) was compared. Results: Axillary surgery confirmed LN metastasis in 81 (24.3%) of the cN0 patients. The clinical tumor size (cT) and age were factors associated with LN metastasis [cT: odds ratio (OR), 2.92, 95% confidence interval (CI): 1.69-5.05, P<0.001; age: OR, 0.33, 95% CI: 0.11-0.99, P=0.048]. However, HNB patients with ≥3 LN metastases were 15 (4.5%) of all the patients. There was statistically significant difference in the incidence of HNB between patients with cT1 tumors (3.6%) and those with cT2 tumors (7.4%) (P<0.001). Conclusions: In cN0, postmenopausal ER-positive/HER2-negative patients who underwent BCT, patients with cT1 tumors had lower rate of LN metastasis, and there were fewer instances of HNB. Therefore, in these patients, omission of axillary surgery including SLNB can be carefully considered.

Nox4 mediates hypoxia-stimulated myofibroblast differentiation in nasal polyp-derived fibroblasts.

BACKGROUND: Chronic hypoxia is associated with remodeling in various organs. Reactive oxygen species (ROS) derived from NADPH oxidases (Nox), and transforming growth factor-ß(1) (TGF-ß(1)) have been implicated in the pathogenesis of hypoxia-induced remodeling. The aims of this study were to determine in hypoxia-stimulated nasal polyp-derived fibroblasts (NPDF) the effect of hypoxia on the differentiation of myofibroblasts, the role of ROS, the major Nox homolog mediating myofibroblast differentiation, and the role of TGF-ß(1). METHODS: Eight primary cultures of NPDF were established from nasal polyps, which were incubated under hypoxic conditions. Reverse transcription polymerase chain reaction for αSMA, Nox1, Nox3, Nox4, Nox5, and fibronectin mRNA was performed. Western blotting for α-SMA and fibronectin was done. ROS production was detected using a fluorometer. NPDF were pretreated with ROS scavengers and transfected with siNox4. The TGF-ß(1) protein level was measured by ELISA. The effect of treatment with TGF-ß(1) type I tyrosine kinase inhibitor SB431542 on myofibroblast differentiation was observed. RESULTS: Hypoxic stimulation of NPDF significantly increased α-SMA and fibronectin mRNA and protein expression. ROS production was increased by hypoxia, and ROS scavengers inhibited myofibroblast differentiation. Nox4 mRNA was the only Nox homolog increased by hypoxia. Transfection with siNox4 inhibited myofibroblast differentiation. TGF-ß(1) was secreted endogenously by hypoxic NPDF. SB431542 significantly inhibited myofibroblast differentiation. CONCLUSIONS: Hypoxia induces myofibroblast differentiation of NPDF through a signaling pathway involving Nox4-dependent ROS generation and TGF-ß(1). Therapies targeting Nox4 may be effective against remodeling of nasal polyps.

Unilateral Pulmonary Edema after Minimally Invasive Cardiac Surgery: A Case Report.

Unilateral pulmonary edema after minimally invasive cardiac surgery is a rare, but potentially life-threatening condition. However, the exact causes of unilateral pulmonary edema remain unclear. We experienced aggressive unilateral pulmonary edema followed by redo-resection of recurrent left atrial myxoma through a right mini-thoracotomy. Intraoperative veno-venous extracorporeal membrane oxygenation was applied after the termination of cardiopulmonary bypass, and separate mechanical ventilation using a double-lumen endotracheal tube was applied after surgery. The patient was successfully treated and discharged uneventfully.

Antiproliferation and redifferentiation in thyroid cancer cell lines by polyphenol phytochemicals.

Thyroid carcinogenesis is accompanied by loss of thyroid-specific functions and refractory to radioiodine and thyroid stimulating hormone (TSH) suppression therapy. Redifferentiating agents have been shown to inhibit tumor growth and improve the response to conventional therapy. Polyphenol phytochemicals (PPs) in fruits and vegetables have been reported to inhibit cancer initiation, promotion, progression and induce redifferentiation in selected types. In this study we examined PPs induce redifferentiation in thyroid cancer cell lines. We investigated the effects of genistein, resveratrol, quercetin, kaempferol, and resorcinol on the F9 embryonal carcinoma cell differentiation model. The thyroid cancer cell lines, TPC-1, FTC-133, NPA, FRO, and ARO, displayed growth inhibition in response to genistein, resveratrol, quercetin. We further demonstrated that genistein decreased the dedifferention marker CD97 in NPA cells and resveratrol decreased CD97 in FTC-133, NPA, FRO cells and quercetin decreased CD97 in all cell lines. We observed increased expression of differentiation marker NIS in FTC-133 cells in response to genistein, and resveratrol but no change in NPA, FRO, ARO cells. Quercetin increased or induced NIS in FTC-133, NPA, FRO cells. These findings suggest that PPs may provide a useful therapeutic intervention in thyroid cancer redifferentiation therapy.

Comparison of Predicted Postoperative Lung Function in Pneumonectomy Using Computed Tomography and Lung Perfusion Scans.

BACKGROUND: Predicting postoperative lung function after pneumonectomy is essential. We retrospectively compared postoperative lung function to predicted postoperative lung function based on computed tomography (CT) volumetry and perfusion scintigraphy in patients who underwent pneumonectomy. METHODS: Predicted postoperative lung function was calculated based on perfusion scintigraphy and CT volumetry. The predicted function was compared to the postoperative lung function in terms of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), using 4 parameters: FVC, FVC%, FEV1, and FEV1%. RESULTS: The correlations between postoperative function and predicted function based on CT volumetry were r=0.632 (p=0.003) for FVC% and r=0.728 (p<0.001) for FEV1%. The correlations between postoperative function and predicted postoperative function based on perfusion scintigraphy were r=0.654 (p=0.002) for FVC% and r=0.758 (p<0.001) for FEV1%. The preoperative Eastern Cooperative Oncology Group (ECOG) scores were significantly higher in the group in which the gap between postoperative FEV1 and predicted postoperative FEV1 analyzed by CT was smaller than the gap analyzed by perfusion scintigraphy (1.2±0.62 vs. 0.4±0.52, p=0.006). CONCLUSION: This study affirms that CT volumetry can replace perfusion scintigraphy for preoperative evaluation of patients needing pneumonectomy. In particular, it was found to be a better predictor of postoperative lung function for poor-performance patients (i.e., those with high ECOG scores).

Multiple Cavernous Hemangiomas of the Posterior Mediastinum, Lung, and Liver: A Case Report.

A 71-year-old male patient visited Yeungnam University Hospital with abnormal chest computed tomography (CT) findings. Chest CT revealed multiple lung nodules and a posterior mediastinal tumor, the diagnosis of which was confirmed surgically. Magnetic resonance imaging (MRI) of the abdomen showed multiple small nodules, which were diagnosed as cavernous hemangioma in the liver based on the pathology results of the mediastinal and lung masses in combination with MRI findings. Cavernous hemangiomas are benign tumors that can occur throughout the body, mainly in the skin and subcutaneous tissue. The liver is the most common internal organ containing hemangiomas, whereas they are very rarely found in the lungs or mediastinum.

COVID-19 vaccine-related axillary lymphadenopathy in breast cancer patients: Case series with a review of literature.

PURPOSE: Lymphadenopathy (LAP) after COVID-19 vaccination in patients with a diagnosis of cancer has been challenging. We analyzed imaging and clinical features from early cases of axillary LAP in six COVID-19 vaccine recipients with a history of breast cancer. METHOD: Among the patients with a history of breast cancer and recent COVID-19 vaccine administration, six patients who showed isolated axillary LAP were gathered. Radiologic features were reviewed from breast ultrasound, chest computed tomography, and breast magnetic resonance imaging. Clinical and pathological information were obtained for analysis. RESULTS: The interval between ultrasound detection of LAP and last COVID-19 vaccine administration ranged from 14 to 28 days (mean 21.67 days). Round shape of the lymph node and irregular cortex were noted in 2 and 0 cases, respectively. Mean maximum cortical thickness, length to width ratio and interval aggravation in maximum cortical thickening were 4.2 mm, 1.34, and 2.81-fold with cut-off value of 3 mm, 1.5, 2.0-fold, respectively. CONCLUSION: We observed axillary LAP ipsilateral to a recent vaccine administration persisting longer than what the Centers for Disease Control and Prevention announced. In our patients, COVID-19 vaccine-related LAP tended to show increased cortical thickness without cortical irregularity. Oncologist as well as radiologist should be familiar with the fact that COVID-19 vaccines, regardless of vaccine type or dosage, can frequently cause ipsilateral axillary LAP, showing some suspicious features more often than others, and can persist longer than anticipated so that both over- and underdiagnosis can be avoided. We report our observations in six patients and provide an exhaustive review of the published literature.

A Randomized Controlled Trial for Doing vs. Omitting Intraoperative Frozen Section Biopsy for Resection Margin Status in Selected Patients Undergoing Breast-Conserving Surgery (OFF-MAP Trial).

PURPOSE: Intraoperative frozen section biopsy is used to reduce the margin positive rate and re-excision rate and has been reported to have high diagnostic accuracy. A majority of breast surgeons in the Republic of Korea routinely perform frozen section biopsy to assess margins intraoperatively, despite its long turnaround time and high resource requirements. This study aims to determine whether omitting frozen section biopsy for intraoperative margin evaluation in selected patients is non-inferior to performing frozen section biopsy in terms of resection margin positivity rate. METHODS: This study is a phase III, randomized controlled, parallel-group, multicenter non-inferiority clinical trial. Patients meeting the inclusion criteria and providing written informed consent will be randomized to the "frozen section biopsy" or "frozen section biopsy omission" group after lumpectomy. Patients with clinical stage T1-T3 disease who are diagnosed with invasive breast cancer by core-needle biopsy and plan to undergo breast-conserving surgery will be included in this study. If a daughter nodule, non-mass enhancement, or microcalcification is identified on preoperative imaging, these features must be within 1 cm of the main mass for inclusion in the trial. The target sample size is 646 patients per arm. The primary endpoint will be the resection margin positive rate, and the secondary endpoints include the reoperation rate, operating time, residual cancer after reoperation, residual cancer after re-excision according to the frozen section biopsy result, resection volume, patient quality of life, and cost-effectiveness. DISCUSSION: This is the first randomized clinical trial utilizing frozen section biopsy for intraoperative margin evaluation and aims to determine the non-inferiority of omitting frozen section biopsy in selected patients compared to performing frozen section biopsy. We expect that this trial will help surgeons perform the procedure more efficiently while ensuring patient safety. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03975179; Clinical Research Information Service Identifier: KCT0004606.

Curcumin suppresses the paclitaxel-induced nuclear factor-kappaB in breast cancer cells and potentiates the growth inhibitory effect of paclitaxel in a breast cancer nude mice model.

Most anticancer agents activate nuclear factor kappa B (NF-kappaB), which can mediate cell survival, proliferation, and metastasis. Curcumin has been shown to inhibit the growth of various cancer cells, without toxicity to normal cells. The antitumor effects of curcumin could be due in part to the inactivation of NF-kappaB. We hypothesize that blocking NF-kappaB activity may augment paclitaxel cancer chemotherapy. In this study, we investigated whether the inactivation of NF-kappaB by curcumin would enhance the efficacy of paclitaxel for inhibiting breast cancer growth in vitro and in vivo. We confirmed that curcumin inhibited paclitaxel-induced activation of NF-kappaB and potentiated the growth inhibitory effect of paclitaxel in MDA-MB-231 breast cancer cells. The combination of curcumin with paclitaxel elicited significantly greater inhibition of cell growth and more apoptosis, compared with either agent alone. In an experimental breast cancer murine model using MDA-MB-231 cells, combination therapy with paclitaxel and curcumin significantly reduced tumor size and decreased tumor cell proliferation, increased apoptosis, and decreased the expression of matrix metalloprotease 9 compared with either agent alone. These results clearly suggest that a curcumin-paclitaxel combination could be a novel strategy for the treatment of breast cancer.

The changes of MRSA infections in chronic suppurative otitis media.

OBJECTIVES: To investigate the epidemiologic and microbiological characteristics of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) infections in the otorrhea of chronic suppurative otitis media (COM) patients. DESIGN: Retrospective study of patients with newly identified MRSA infections from January 1998 through December 2006. A total of 2773 patients with a diagnosis of COM were included in this study. An antibiotic sensitivity test was performed for each isolate. RESULTS: The prevalence of MRSA in COM was 4.9 percent (137 of 2773 patients). The proportion of CA-MRSA rose from 0.7 percent in 1998 to 11.4 percent in 2006. However, the proportion of HA-MRSA did not change significantly, from 0.7 percent in 1999 to 1.3 percent in 2006. All of the CA-MRSA strains identified in our study were susceptible to trimethoprim/sulfamethoxazole (TMP/SMX). Rifampin susceptibility was also noted in 90 percent of the cases. CONCLUSIONS: CA-MRSA infections have risen dramatically in the past decade. CA-MRSA and HA-MRSA in COM differed in both clinical and microbiological aspects.

Expression of oncostatin M in chronic obstructive sialadenitis of the submandibular gland.

OBJECTIVES: We investigated the expression of oncostatin M messenger RNA (mRNA) and protein in normal submandibular glands and those with chronic obstructive sialadenitis and localized the expression of oncostatin M protein. METHODS: Submandibular glands from 10 patients with chronic obstructive sialadenitis as a study group and 10 normal submandibular glands as a control group were examined. Oncostatin M mRNA extracted from submandibular gland was used for reverse transcription-polymerase chain reaction and analyzed semiquantitatively. The difference in expression level of oncostatin M protein between the 2 groups was analyzed through Western blot analysis, and oncostatin M protein was localized immunohistochemically. RESULTS: The expression levels of oncostatin M mRNA and protein were significantly increased in the study group. The protein was predominantly localized in ductal epithelia and infiltrating inflammatory cells and was more strongly expressed in the study group also. CONCLUSIONS: Oncostatin M is expressed in both chronic obstructive sialadenitis and normal submandibular gland, and is up-regulated in chronic obstructive sialadenitis. These results suggest that oncostatin M is involved in the pathologic process of chronic obstructive sialadenitis. However, the physiologic role in normal glands, as well as a possible role in the development of chronic obstructive sialadenitis, remains to be elucidated.

Up-regulation of protease-activated receptor 2 in allergic rhinitis.

OBJECTIVES: We compared the patterns of PAR-2 messenger RNA (mRNA) and protein expression in the nasal mucosa of subjects with and without allergic rhinitis. METHODS: Biopsy specimens were obtained from 10 patients with allergic rhinitis and 10 normal controls. RNA was extracted from the nasal mucosa, and semiquantitative reverse transcription-polymerase chain reaction was performed for PAR-2. Tissue sections were immunostained for PAR-2 by use of specific antibody. RESULTS: The expression levels of PAR-2 mRNA in allergic rhinitis nasal mucosa were significantly up-regulated as compared with those in normal nasal mucosa. PAR-2 immunoreactivity was observed in the epithelium and submucosal glands in both normal controls and subjects with allergic rhinitis. Stronger immunoreactivity for PAR-2 was observed in allergic rhinitis nasal mucosa as compared with normal nasal mucosa. CONCLUSIONS: These results suggest that PAR-2 may be involved in allergic nasal inflammation.

Up-regulation of peroxidase proliferator-activated receptor gamma in cholesteatoma.

OBJECTIVE: To evaluate the localization and expression of peroxidase proliferator-activated receptor (PPAR)gamma in cholesteatoma epithelium. STUDY DESIGN: Experimental study. METHODS: Reverse-transcription polymerase chain reaction was performed on cholesteatoma tissues from 10 adult patients undergoing tympanomastoid surgery for middle ear cholesteatoma and on 10 samples of normal external auditory canal skin tissue. The expression levels of PPARgamma to glyceraldehyde-3-phosphate dehydrogenase transcripts were semiquantified by densitometry. We also characterized the cellular localization of the PPARgamma protein immunohistochemically. Ki-67 was also localized to compare the proliferative activity of cells in cholesteatoma epithelium and in normal external auditory canal skin. RESULTS: PPARgamma mRNA and protein were detected in normal external auditory canal skin and in cholesteatoma epithelium. The expression level of PPARgamma mRNA in cholesteatoma was significantly increased compared with that in normal external auditory canal skin. PPARgamma protein was expressed in cells mainly in the granular and prickle cell layers. However, the intensity of its expression was generally decreased in the parabasal layer of the cholesteatoma epithelium. Ki-67 was expressed in the nuclei of cells in the basal and parabasal layers, and a greater number of cells were Ki-67 immunopositive in cholesteatoma epithelium. CONCLUSION: PPARgamma is up-regulated in the cholesteatoma epithelium compared with normal external auditory canal skin. These results suggest that PPARgamma may play an important role in the pathogenesis of cholesteatoma.

Treatment of ranula in pediatric patients with intralesional injection of OK-432.

OBJECTIVE: To assess the efficacy of treatment of a ranula in children by intralesional injection of OK-432. STUDY DESIGN: Retrospective analysis of 13 cases. METHODS: Review of medical records of pediatric patients with ranula treated by OK-432 sclerotherapy from 2002 through 2005. RESULTS: Among 13 cases, 9 were completely regressed by injection therapy alone. Three cases were incompletely regressed. One case was cured by surgical excision. The follow-up duration was 6 to 46 (mean 24.3) months. Adverse effects of OK-432 injection were tolerable, and no complication was observed. CONCLUSIONS: On the basis of our experience, sclerotherapy with OK-432 was a safe and effective primary treatment for a ranula in children. Further study will be needed to conclude its long-term effectiveness.

Upregulation of surfactant protein A in chronic rhinosinusitis.

OBJECTIVES: Surfactant protein A (SP-A) is protein that appears to play an important role in mammalian first-line host defense. However, the presence of SP-A in the human paranasal sinus mucosa is not well known. The purpose of this study was to investigate the expression of SP-A protein in human paranasal sinus mucosa and to compare the expression of SP-A mRNA between normal paranasal sinus mucosa and paranasal sinus mucosa with chronic rhinosinusitis. METHODS: Paranasal sinus mucosa samples from 10 patients who underwent surgery for chronic rhinosinusitis without polyps and 10 normal control subjects were used. Reverse transcriptase polymerase chain reaction was done to detect SP-A mRNA. The expression level of SP-A transcripts was semiquantified with desitometry. Cellular localization of SP-A was sought by using immunohistochemistry. RESULTS: SP-A mRNA and protein were expressed in the human paranasal sinus mucosa. SP-A/GAPDH mRNA ratio in the paranasal sinus mucosa with chronic rhinosinusitis was greater compared with that in normal paranasal sinus mucosa (P<.05). Immunohistochemical staining revealed SP-A immunoreactivity in the epithelial cells and submucosal glands of paranasal sinus mucosa in both control subjects and chronic sinusitis patients. Stronger immunoreactivity was observed in chronic rhinosinusitis mucosa as compared with normal paranasal sinus mucosa. CONCLUSION: SP-A mRNA and protein are present in both normal and diseased human paranasal sinus mucosa. These results may provide potential targets for novel therapy of chronic rhinosinusitis.

Efficacy of sucralfate in the postoperative management of uvulopalatopharyngoplasty: a double-blind, randomized, controlled study.

OBJECTIVE: To evaluate the effectiveness of sucralfate in influencing throat pain, otalgia, analgesic requirement, bleeding, mucosal recovery, and incidence of postoperative bleeding in patients undergoing uvulopalatopharyngoplasty. DESIGN: A prospective double-blind randomized study. SETTING: University-affiliated tertiary referral hospital. PARTICIPANTS: Eighty adult patients with obstructive sleep apnea syndrome requiring uvulopalatopharyngoplasty were recruited and randomly allocated into either a sucralfate treatment group or a control group. INTERVENTIONS: All patients underwent uvulopalatopharyngoplasty. Patients enrolled in the sucralfate group (n=40) were instructed to gargle the sucralfate suspension and then to swallow. Patients enrolled in the control group (n=40) were instructed to gargle placebo suspension at the same doses and schedule. MAIN OUTCOME MEASURES: Postoperative throat pain, otalgia, amount of analgesic required, degree of strength (defined as patients' general well-being and return to regular daily activities), percentage of mucosal covering, and postoperative bleeding. RESULTS: Throat pain and otalgia occurred significantly less often in sucralfate group, with less analgesic requirement and with rapid mucosal healing and early return to regular daily activities. There was no significant difference in episodes of postoperative bleeding between the 2 groups (P=.37). CONCLUSIONS: Although sucralfate therapy may not provide complete analgesia after uvulopalatopharyngoplasty, it may reduce the amount of analgesic required, thus preventing dose-related adverse effects from the analgesic agent. It can also significantly reduce the total number of days needed to return to normal daily activities (P=.41).

Up-regulation of peroxisome proliferator-activated receptor gamma in perennial allergic rhinitis.

OBJECTIVES: To investigate the expression of peroxisome proliferator-activated receptor gamma (PPAR-gamma) messenger RNA and protein and to localize the PPAR-gamma protein in the nasal mucosa of patients with allergic rhinitis and control subjects. DESIGN: Prospective study. SETTING: Tertiary academic institution. Patients Twenty patients with perennial allergic rhinitis and 20 matched nonallergic patients. INTERVENTIONS: Inferior turbinate mucosa samples were obtained from 20 patients with perennial allergic rhinitis and 20 matched nonallegic patients. Peroxisome proliferator-activated receptor gamma messenger RNA was extracted from the inferior turbinate mucosae, and then reverse transcription-polymerase chain reaction was performed. Western blot testing was used to analyze differences in PPAR-gamma protein expression levels between patients with allergic rhinitis and normal controls, and the PPAR-gamma protein was localized immunohistochemically. RESULTS: The expression levels of PPAR-gamma messenger RNA and protein in the nasal mucosa was significantly increased in patients with perennial allergic rhinitis compared with controls. Peroxisome proliferator-activated receptor gamma protein was expressed in the epithelium, infiltrating inflammatory cells, and submucosal glands. CONCLUSIONS: Peroxisome proliferator-activated receptor gamma is expressed in the human nasal mucosa and is up-regulated in perennial allergic rhinitis. These results suggest a possible contribution for PPAR-gamma in chronic inflammation of the nasal mucosa in perennial allergic rhinitis.

Up-regulation of chemokine ligand 20 in chronic rhinosinusitis.

OBJECTIVES: To investigate the up-regulation of chemokine ligand 20 (CCL20) in chronic rhinosinusitis mucosa and to localize the distribution of CCL20 in the human paranasal sinus mucosa. DESIGN: Prospective study. SETTING: Tertiary academic institution. PATIENTS: Ten patients who underwent functional endoscopic sinus surgery for chronic rhinosinusitis without nasal polyps and 10 normal control subjects. INTERVENTIONS: Messenger RNA was extracted from the sinus mucosa, and semiquantitative reverse transcriptase-polymerase chain reaction was performed. Immunohistochemical staining was used to localize the CCL20 protein. RESULTS: The expression levels of CCL20 messenger RNA level in chronic rhinosinusitis without nasal polyps were significantly increased compared with those in normal sinus mucosa. The expression of CCL20 protein was greater in chronic rhinosinusitis without nasal polyps mucosa and was localized to the epithelial and submucosal glandular cells. CONCLUSION: CCL20 is an inducible product of human paranasal sinus epithelium that may play a role in modulating mucosal immunity of the sinus mucosa.

Interleukin-18/-607 gene polymorphism in allergic rhinitis.

OBJECTIVES: Allergic rhinitis is a chronic inflammatory disease with a genetic background, and IL-18 (formerly IFN-gamma-inducing factor) is a well-known pro-inflammatory cytokine. The aim of this study was to investigate whether the IL-18/-607 promoter polymorphisms were associated with allergic rhinitis in the Korean population. STUDY DESIGN: Prospective study. METHODS: Deoxyribonucleic acid was obtained from the blood samples of 160 Korean children with allergic rhinitis and from 166 healthy controls. The IL-18/-607 polymorphism was analyzed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis. RESULTS: The frequency of the AC genotype of the IL-18/-607 gene polymorphism was significantly greater in allergic rhinitis patients than in controls (P<0.05). CONCLUSIONS: The A allele in the IL-18/-607 gene promoter region may be involved in the development of allergic rhinitis in the Korean population.