Postoperative results of ventilation tube insertion: a retrospective multicenter study for suggestion of grading system of otitis media with effusion.

BACKGROUND: In otitis media with effusion (OME), it is important to know when to surgically intervene and when careful monitoring is more appropriate. This study aimed to visualize and classify the clinical manifestations of OME and the correlation between the new grading system and postoperative results after ventilation tube insertion (VTI). METHODS: We classified the collective 1,012 ears from 506 patients into six groups: grade 0 (no effusion), grade I (scant effusion, but abnormal), grade II (effusion less than half of the tympanic cavity), grade III (effusion over half of the tympanic cavity, with air bubbles), grade IV (complete effusion), and grade V (retracted tympanic membrane or hemotympanum without air bubbles). RESULTS: The mean age at VTI was 5.2 (±2.9) years and mean duration between diagnosis and operation was 4.1 (±1.8) months. Between the grades, the nature of the middle ear effusion was also significantly different (p < 0.001). The duration of ventilation tube retention after VTI was significantly different when compared between two groups: grade I-IV and grade V (p = 0.019). Our results showed that the recurrence rate, as well as rate of revision VTI, increased as the grade increased (p < 0.001). CONCLUSIONS: The new grading system of OME using endoscopic otoscope evaluation had a significant correlation with the age at VTI, the nature of middle ear effusion, the recurrence rate of OME, and the rate of revision VTI.

Changes of visualised Eustachian tube lengths by age and position: Radiologic study in sitting and supine positions using cone beam and conventional CT.

OBJECTIVES: Patulous eustachian tube (ET) has been characterised by the visualisation of full-length ET on computed tomography (CT) results. We wanted to investigate the changes of visualised ET lengths by age in supine and sitting positions. DESIGN: Retrospective study. SETTING: Tertiary care academic referral centre. PARTICIPANTS: One hundred subjects who underwent cone beam CT (CBCT) in a sitting position and conventional CT in a supine position for non-otitis-related or dental complaints. MAIN OUTCOME MEASURES: Visualised ET lengths from the nasopharyngeal orifice measured by different positions and ages. RESULTS: Subjects did not show visualisation of full-length ET throughout the study. The visualised ET lengths (9.0 ± 2.5 mm) of the CBCT group were significantly larger than those (6.8 ± 2.3 mm) of the conventional CT group (P < 0.0001).Women showed longer visualised ET lengths than men in CBCT group (P < 0.001). The visualised ET lengths of the CBCT group were consistent or slightly increasing as a function of age (P = 0.06); however, the visualised ET lengths of the conventional CT group decreased as a function of age (P = 0.001). The slopes of regression lines of the two groups were significantly different. CONCLUSIONS: When in the supine position, the ET lengths gradually shortened as the subjects got older, most likely due to venous engorgement and the collapse of surrounding tissues; this finding thus suggests that CT in a supine position is an inappropriate method to diagnose patulous ET. The visualised ET lengths by CBCT in a sitting position were consistent throughout the different ages of the subjects and may be used as a diagnostic test for patulous ET.

Fluoroscopic subtraction Eustachian tubography: initial feasibility test in a cadaver model.

OBJECTIVES: To evaluate the technical feasibility of direct Eustachian tube catheterisation and subtraction Eustachian tubography in a cadaver model. METHODS: A total of 12 separate sessions were performed on both sides of the Eustachian tube (ET) in six human cadavers. Cadavers were positioned for the submentovertical view on a fluoroscopy table. Endoscopy-guided ET selection was used in the first three cadavers, whereas fluoroscopy-guided ET selection was used in the remaining three. Eustachian tubography was performed by injecting 2 ml of contrast media through a 5-Fr catheter. We recorded the success of ET selection, number of attempts, procedure time, and tubography quality using native and subtraction images (range, 0-3). RESULTS: Both endoscopy- and fluoroscopy-guided selections were successfully performed in five of six sessions (83.3%). There were no statistically significant differences between the endoscopy- and fluoroscopy-guided procedures in terms of the number of attempts, procedure time, rate of immediate contrast leak to the middle ear cavity, and quality of tubography (p > 0.05). An excellent quality of tubography was obtained in 83.3% (10 of 12 sessions) of subtraction images and in 33.3% (4 of 12 sessions) of native images. The tubography quality score was significantly higher for the subtraction images than for the native images (p = 0.04). CONCLUSION: Subtraction Eustachian tubography using direct catheterisation seems to be technically feasible. The entire ET can be well visualised; thus, this technique can be used as a simple tool for assessment of ET function and anatomy. KEY POINTS: • Direct catheterisation of the Eustachian tube is technically feasible. • The entire Eustachian tube could be well visualised by direct Eustachian tubography. • Subtraction Eustachian tubography images have better image quality than native images. • Subtraction Eustachian tubography can provide objective assessment of ET function and anatomy.

Transnasal Placement of a Balloon-Expandable Metallic Stent: Human Cadaver Study of the Eustachian Tube.

PURPOSE: To investigate the technical feasibility of stent placement in the cartilaginous portion of the Eustachian tube (ET). MATERIALS AND METHODS: Twelve ETs of 6 cadavers were used. Two different-sized stents were placed on either the right (2.5 mm in diameter) or left (3.5 mm in diameter) side of the ET. The procedural feasibility was assessed by subtraction Eustachian tubography, computed tomography before and after the procedure, and fluoroscopic and endoscopic images. The stent location, inner luminal diameter of the stented ET, radiation dose, procedural time, and fluoroscopy time were analyzed. RESULTS: Stent placement was successful in 11 of 12 cadaveric specimens without procedure-related complications. In the 1 specimen, the balloon catheter with crimped stent was passed into the bony canal of the ET without any resistance. The distal end of the stent was located in the middle ear cavity. Stents were located within the cartilaginous portion of the ET (n = 1), the proximal tip bridging the nasopharyngeal orifice of the ET (n = 5), or the proximal end of the stent protruded from the tubal orifice (n = 5). The mean luminal diameter in the outer segment was significantly smaller than in the middle (P < .001) and inner (P < .001) segments. The mean procedure time was 128 ± 37 seconds. The mean radiation dose and fluoroscopy time of each cadaver were 3235.4 ± 864.8 cGy/cm2 and 139 ± 49 seconds, respectively. CONCLUSIONS: Stent placement of the ET under endoscopic and fluoroscopic guidance is technically feasible in a human cadaver model.

Fluoroscopic balloon diameter measurement at different pressures during Eustachian balloon dilation.

OBJECTIVES: To measure the diameter of inflated balloons at different pressures during Eustachian tube (ET) balloon dilation under fluoroscopic guidance. DESIGN: Prospective cohort study. SETTING: Tertiary academic referral centre. PARTICIPANTS: Eighteen patients who underwent ET balloon dilation with use of a balloon catheter, 20 mm long and 6 mm in diameter, under combined endoscopic and fluoroscopic guidance. MAIN OUTCOME MEASURES: Degrees of inflation at three different portions (proximal, middle and distal) of the balloon at controlled pressures (3, 5, 8 and 10 atmospheres [atm]) and at the maximum pressure manually applied. RESULTS: The mean proximal, middle and distal diameters of the inflated balloons were 5.3 ± 0.4 mm, 5.3 ± 0.4 mm and 4.9 ± 0.5 mm at 10 atm. The distal diameters were significantly smaller than middle and proximal diameters at all the pressures (P < 0.01). When compared to the distal diameter (100%, 4.9 ± 0.5 mm) at 10 atm, the distal diameters were 73% (3.6 ± 0.6 mm) at 3 atm, 88% (4.3 ± 0.5 mm) at 5 atm and 96% (4.7 ± 0.4 mm) at 8 atm. The distal diameter (4.1 ± 0.3 mm) at the maximum pressure manually applied was in between those at 3 and 5 atm. CONCLUSIONS: The distal diameter of the balloon increased significantly as a function of the pressure and most (88%) inflation occurred at a low pressure of 5 atm, which was sufficient to inflate the distal diameter of the balloon more than 3 mm. The manual pressurisation could inflate a balloon by as much as could be expected, at between 3 and 5 atm.

Preoperative 3-dimensional Magnetic Resonance Imaging of Uterine Myoma and Endometrium Before Myomectomy.

Uterine myomas are the most common gynecologic benign tumor affecting women of childbearing age, and myomectomy is the main surgical option to preserve the uterus and fertility. During myomectomy for women with multiple myomas, it is advisable to identify and remove as many as possible to decrease the risk of future myomectomies. With deficient preoperative imaging, gynecologists are challenged to identify the location and size of myomas and the endometrium, which, in turn, can lead to uterine rupture during future pregnancies. Current conventional 2-dimensional imaging has limitations in identifying precise locations of multiple myomas and the endometrium. In our experience, we preferred to use 3-dimensional imaging to delineate the myomas, endometrium, or blood vessels, which we were able to successfully reconstruct by using the following imaging method. To achieve 3-dimensional imaging, we matched T2 turbo spin echo images to detect uterine myomas and endometria with T1 high-resolution isotropic volume excitation-post images used to detect blood vessels by using an algorithm based on the 3-dimensional region growing method. Then, we produced images of the uterine myomas, endometria, and blood vessels using a 3-dimensional surface rendering method and successfully reconstructed selective 3-dimensional imaging for uterine myomas, endometria, and adjacent blood vessels. A Web-based survey was sent to 66 gynecologists concerning imaging techniques used before myomectomy. Twenty-eight of 36 responding gynecologists answered that the 3-dimensional image produced in the current study is preferred to conventional 2-dimensional magnetic resonance imaging in identifying precise locations of uterine myomas and endometria. The proposed 3-dimensional magnetic resonance imaging method successfully reconstructed uterine myomas, endometria, and adjacent vessels. We propose that this will be a helpful adjunct to uterine myomectomy as a preoperative imaging technique in future studies.

Clinical significance of pretreatment metabolic tumor volume and total lesion glycolysis in hypopharyngeal squamous cell carcinomas.

BACKGROUND: To evaluate the usefulness of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by pretreatment fluorine 18-fluorodeoxyglucose ((18) F-FDG) positron emission tomography (PET)/computed tomography (CT) as predictors of clinical outcome in hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: Seventy-eight patients with HPSCC treated with definitive radiotherapy with or without chemotherapy underwent (18) F-FDG PET/CT. Maximum standardized uptake value (SUV max ), MTV, and TLG were measured. For calculation of MTV, 3-D regions of interest were drawn and a SUV threshold of 2.5 was used for defining region. Univariate and multivariate analyses identified variables associated with disease-free survival (DFS) and overall survival (OS). RESULTS: Median SUV max , MTV, and TLG were 9.0 (range, 1.7-24.5), 20.5 (0.3-339.9) ml, and 98.9 (0.8-1877.1) g, respectively. The four-year DFS and OS were 56.1% and 52.6%, respectively. On univariate and multivariate analyses, MTV (P = 0.014) and TLG (P = 0.029) were independent prognostic factors for DFS, and MTV (P = 0.002) and TLG (P = 0.002) were independent prognostic factors for OS. CONCLUSION: MTV and TLG measured by pretreatment (18) F-FDG PET/CT may be useful in predicting the clinical outcomes of HPSCC patients undergoing radiotherapy.

Candidates for limited lateral neck dissection among patients with metastatic papillary thyroid carcinoma.

BACKGROUND: Papillary thyroid carcinoma (PTC) is associated with an excellent prognosis but frequently spreads to regional lymph nodes. The extent of neck dissection, particularly routine level II or V lymphadenectomy, is still controversial as it may lead to spinal accessory nerve injury and associated postoperative morbidities. We assessed the diagnostic value of preoperative ultrasonography (US) plus computed tomography (CT) for detecting metastatic lymph nodes and for identifying predictors of level II or V metastasis in patients with PTC. METHODS: The results of US and CT were compared with histopathologic findings at various neck levels in 209 previously untreated PTC patients with lateral cervical nodal metastases who underwent total thyroidectomy with central and lateral neck dissection. Clinicopathologic predictors for level II or V metastases were identified. RESULTS: Pathologic metastases to level II and V were observed in 53.6 and 25.4 % of patients, respectively. Occult metastases were found in 34.5 and 16.8 %, respectively. The sensitivities of US plus CT for levels II and V were 64.6 and 50.9 %, respectively. Image-based, isolated lateral level IV involvement and macroscopic extranodal extension were independently associated with level II metastasis or either level II or V metastasis (p < 0.01). Macroscopic extranodal extension was also independently associated with level V metastasis (p = 0.001). CONCLUSIONS: Patients with image-based, isolated lateral level IV involvement and no macroscopic extranodal extension are potential candidates for limited level III-IV dissection or prophylactic level II lymphadenectomy omission. Level V lymphadenectomy may be omitted in patients without macroscopic extranodal extension.

Tumor necrosis in magnetic resonance imaging predicts urothelial carcinoma with squamous differentiation in muscle-invasive bladder carcinoma.

PURPOSE: This study investigated radiologic features on preoperative MRI to differentiate urothelial carcinoma with squamous differentiation (UCSD) from conventional urothelial carcinoma (UC) in muscle-invasive bladder carcinoma. METHODS: Ninety-nine patients who underwent radical cystectomy and a preoperative bladder MRI scan within three months before surgery were retrospectively enrolled. Various MRI features, including tumor length, location, multiplicity, long-to-short axis ratio, morphology, radiologic stage, and degree of severe necrosis, were analyzed. Univariable and multivariable logistic regression analyses were performed to identify MRI features predictive of UCSD. The diagnostic performance of a significant MRI feature was assessed using 5-fold cross-validation. RESULTS: Among the MRI features, significant radiologic findings associated with UCSD in the univariable analysis included heterogeneous tumor signal intensity in T2-weighted images (odds ratio [OR], 3.365; 95% confidence interval [CI], 1.213-9.986; P = 0.022) and contrast-enhanced T1-weighted images (OR, 4.428; 95% CI, 1.519-12.730; P = 0.007), as well as marked (≥ 50%) severe necrosis (OR, 17.100; 95% CI, 4.699-73.563; P < 0.001). In the multivariable analysis, marked (≥ 50%) severe necrosis (odds ratio [OR], 13.755; 95% confidence interval [CI], 2.796-89.118; P = 0.004) was a significant predictor of UCSD. Marked (≥ 50%) severe necrosis showed a high specificity of 95.0% with a precision of 65.0% for diagnosing UCSD based on 5-fold cross-validation. CONCLUSION: Preoperative bladder MRI revealing marked severe necrosis may be indicative of UCSD and can assist in distinguishing it from conventional UC.

Peripheral zone thickness in preoperative MRI is predictive of Trifecta achievement after Holmium laser enucleation of the prostate (HoLEP).

PURPOSE: To investigate various anatomical features of the prostate using preoperative MRI and patients' clinical factors to identify predictors of successful Holmium:YAG laser enucleation of the prostate (HoLEP). METHODS: 71 patients who had received HoLEP and undergone a 3.0-T prostate MRI scan within 6 months before surgery were retrospectively enrolled. MRI features (e.g., total prostate and transitional zone volume, peripheral zone thickness [PZT], BPH patterns, prostatic urethral angle, intravesical prostatic protrusion, etc.) and clinical data (e.g., age, body mass index, surgical technique, etc.) were analyzed using univariable and multivariable logistic regression to identify predictors of successful HoLEP. Successful HoLEP was defined as achieving the Trifecta, characterized by the contemporary absence of postoperative complications within 3 months, a 3-month postoperative maximum flow rate (Qmax) > 15 mL/s, and no urinary incontinence at 3 months postoperatively. RESULTS: Trifecta achievement at 3 months post-surgery was observed in 37 (52%) patients. Patients with Trifecta achievement exhibited a lower preoperative IPSS-quality of life score (QoL) (4.1 vs. 4.5, P = 0.016) and a thinner preoperative peripheral zone thickness (PZT) on MRI (7.9 vs.10.3 mm, P < 0.001). In the multivariable regression analysis, a preoperative IPSS-QoL score < 5 (OR 3.98; 95% CI, 1.21-13.07; P = 0.017) and PZT < 9 mm (OR 11.51; 95% CI, 3.51-37.74; P < 0.001) were significant predictors of Trifecta achievement after HoLEP. CONCLUSIONS: Alongside the preoperative QoL score, PZT measurement in prostate MRI can serve as an objective predictor of successful HoLEP. Our results underscore an additional utility of prostate MRI beyond its role in excluding concurrent prostate cancer.

Catalytic asymmetric insertion of diazoesters into aryl-CHO bonds: highly enantioselective construction of chiral all-carbon quaternary centers.

This paper describes a catalytic enantioselective route to synthesize functionalized all-carbon quaternary acyclic systems via a boron Lewis acid-promoted formal C-C insertion of diazoesters into aryl-CHO bonds. In the presence of chiral (S)-oxazaborolidinium cation 1d as a catalyst, the reaction proceeded in good yield (up to 83%) with good regioselectivity (up to 88:12) and excellent enantioselectivity (up to 99% ee). The synthetic potential of this method was illustrated by conversion of the products to both α- and ß-amino esters.

Usefulness of computed tomography in the etiologic evaluation of adult unilateral vocal fold paralysis.

BACKGROUND: Unilateral vocal fold paralysis (UVFP) may present as an uncommon complication of extralaryngeal neoplasms, requiring diagnostic scrutiny to seek occult tumors or diseases. The aim of this study was to examine the utility of computed tomography (CT) in evaluating adult UVFP of unknown etiology. METHODS: From January 2010 to December 2011, UVFP was diagnosed in 822 patients at our tertiary-care center. In 634 patients, a readily identifiable cause of the UVFP was evident and therefore there was no need for any imaging; in the remaining 188 patients, the etiology could not be determined. Among this latter group, 153 patients underwent chest radiography (CXR) and contrast-enhanced CT imaging from the skull base to the midchest. RESULTS: In 36 of the 153 (23.5 %) patients, CT revealed the cause of the UVFP: lung cancer in 12 patients, thyroid carcinoma in 7 patients, skull-base tumor in 4 patients, aortic aneurysm in 4 patients, esophageal cancer in 3 patients, thymus tumor in 2 patients, pericardial effusion in 1 patient, and other neck lesions in 3 patients. CXR and neck ultrasonography also identified the etiology in 14 and 12 patients, respectively. During follow-up after the initial CT, none of the patients with idiopathic UVFP was determined to have an underlying disease that would have explained the paralysis. CONCLUSION: CT is a useful single-imaging method for evaluating the etiology of adult UVFP. This approach may reveal occult tumors or previously undiagnosed diseases as the cause of the paralysis, thus improving patient care.

Prevalence of vestibular migraine in an otolaryngologic clinic: Preliminary clinical diagnosis versus diagnosis according to the strictly applied Bárány criteria.

BACKGROUND: Diagnostic criteria of vestibular migraine (VM) by the Bárány classification consists of complex combinations of characteristics of dizziness: episodes, intensity, duration, migraine according to International Classification of Headache Disorders (ICHD), and migraine features accompanying vertigo. The prevalence according to strictly applied Bárány criteria may be much lower than preliminary clincal diagnosis. OBJECTIVE: The purpose of this study is to investigate the prevalence of VM according to strictly applied Bárány criteria among dizzy patients who visited the otolaryngology department. METHODS: The medical records of patients with dizziness from December 2018 to November 2020 were retrospectively searched using a clinical big data system. The patients completed a questionnaire designed to identify VM according to Bárány classification. Microsoft Excel function formulas were used to identify cases that met the criteria. RESULTS: During the study period, 955 new patients visited the otolaryngology department complaining of dizziness, of which 11.6% were assessed as preliminary clinical diagnosis of VM in outpatient clinic. However, VM according to strictly applied Bárány criteria accounted for only 2.9% of dizzy patients. CONCLUSION: The prevalence of VM according to strictly applied Bárány criteria could be significantly lower than that of preliminary clinical diagnosis in outpatient clinic.

Dexamethasone treatment of murine auditory hair cells and cochlear explants attenuates tumor necrosis factor-α-initiated apoptotic damage.

The most common cause of sensorineural hearing loss is damage of auditory hair cells. Tumor necrosis factor-alpha (TNF-α) is closely associated with sensorineural hearing loss. The present study examined the preconditioning effect of dexamethasone (DEX) on TNF-α-induced ototoxicity in mouse auditory hair cells (HEI-OC1) and cochlear explants. Treatment of HEI-OC1 with 10 ng/ml TNF-α for 24 h decreased cell viability, increased the accumulation of reactive oxygen species (ROS), and induced caspase-mediated apoptotic signaling pathways. Pretreatment with 10 nM DEX for 6 h before TNF-α exposure restored cell viability, decreased ROS accumulation, and attenuated apoptotic signaling activation induced by TNF-α. Incubation of cochlear explants with 20 ng/ml TNF-α for 24 h resulted in significant loss of both inner hair cells (IHCs) and outer hair cells (OHCs) and an increase in apoptotic activation accessed by annexin V staining. The cochlear explants pre-incubated with 10 nM DEX attenuated TNF-α ototoxicity in both IHCs and OHCs and apoptotic cell death. These results indicated that DEX plays a protective role in ototoxicity induced by TNF-α through attenuation of caspase-dependent apoptosis signaling pathway and ROS accumulation.

Differential Involvement of Lateral Semicircular Canal and Otolith Organs in Common Vestibular Disorders.

Semicircular canal and otolith functions came to be evaluated recently, but comprehensive and comparative analysis of canal and otolith dysfunction in common vestibular disorders is lacking. We aimed to analyze the abnormal rates of canal and otolith function in common vestibular disorders. We enrolled 302 patients who were managed for 2 months in a dizziness clinic. Results of caloric, video head impulse test (vHIT), and cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP) tests were analyzed and compared among various diagnoses. Vestibular disorders diagnosed included recurrent vestibulopathy (RV, 27%), vestibular migraine (VM, 21%), benign paroxysmal positional vertigo (BPPV, 17%), Meniere's disease (MD, 11%), vestibular neuritis (VN, 10%), orthostatic dizziness (7%), and central lesions (3%). Lateral canal dysfunction was found most in VN (100%) and less commonly in definite MD (75%), RV (46%) and definite VM (29%). Abnormal caloric results were more common than abnormal vHIT in all disorders. Otolith dysfunction was found more frequently than lateral canal dysfunction in most vestibular disorders except VN. An abnormal cVEMP was more frequent in definite MD than the other disorders. Isolated otolith dysfunction without lateral canal dysfunction was the most found in BPPV, followed by definite VM, RV, and definite MD in decreasing order. Various patterns of involvement in canal and otoliths were revealed in vestibular disorders, suggesting different pathogenesis.

Hearing Outcomes of Stapes Surgery in Children With Stapes Fixation and Ossicular Anomalies.

OBJECTIVES: To investigate hearing outcomes after stapes surgery in children with stapes fixation. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: Forty-nine patients (66 ears) aged less than 15 years who received stapes surgery. INTERVENTIONS: Stapes surgery. MAIN OUTCOMES AND MEASURES: Preoperative symptoms, bilateral involvement, pure-tone hearing levels, and perioperative complications were analyzed using paired t test and Mann-Whitney U test. RESULTS: The chief complaint of all patients was hearing disturbance. Sixteen ears were diagnosed with stapes fixation and an additional congenital ossicular anomaly and 50 ears had only stapes fixation. Preoperative mean bone conduction and air conduction thresholds were 12.0 ±â€Š5.8 dB and 60.9 ±â€Š10.9 dB, respectively. The mean air-bone gap (ABG) was 48.9 ±â€Š12.0 dB in patients with stapes fixation and an ossicular anomaly. The postoperative mean ABG was 23.6 ±â€Š14.5 dB, and the ABG closure was 25.3 ±â€Š18.2 dB. In patients with stapes fixation only, the preoperative mean bone conduction and air conduction thresholds were 14.3 ±â€Š7.5 dB and 49.6 ±â€Š9.5 dB, respectively, and the mean ABG was 35.5 ±â€Š9.6 dB. The postoperative mean ABG was 14.4 ±â€Š10.3 dB, and the ABG closure was 16.2 ±â€Š16.1 dB. The successful results (ABG <20 dB) were 75.8% overall, 56.3% for fixation and an ossicular anomaly, and 82.0% for fixation only. CONCLUSIONS: In children with stapes fixation, hearing loss was worse when the fixation was combined with an ossicular anomaly. Ossicular continuity, especially of the incus, is the most important factor for successful stapes surgery. Appropriate diagnosis and surgical intervention can lead to good results for children with stapes fixation.

EPHA3 Contributes to Epigenetic Suppression of PTEN in Radioresistant Head and Neck Cancer.

EPHA3, a member of the EPH family, is overexpressed in various cancers. We demonstrated previously that EPHA3 is associated with radiation resistance in head and neck cancer via the PTEN/Akt/EMT pathway; the inhibition of EPHA3 significantly enhances the efficacy of radiotherapy in vitro and in vivo. In this study, we investigated the mechanisms of PTEN regulation through EPHA3-related signaling. Increased DNA methyltransferase 1 (DNMT1) and enhancer of zeste homolog 2 (EZH2) levels, along with increased histone H3 lysine 27 trimethylation (H3K27me3) levels, correlated with decreased levels of PTEN in radioresistant head and neck cancer cells. Furthermore, PTEN is regulated in two ways: DNMT1-mediated DNA methylation, and EZH2-mediated histone methylation through EPHA3/C-myc signaling. Our results suggest that EPHA3 could display a novel regulatory mechanism for the epigenetic regulation of PTEN in radioresistant head and neck cancer cells.

T1-Staging for Urinary Bladder Cancer with the Stalk and Inchworm Signs with 3.0 Tesla MRI.

Purpose: To evaluate the diagnostic utility of the stalk and the inchworm sign on preoperative MRI for detecting superficial bladder cancers, and to compare the diagnostic performance between the stalk and the inchworm sign. Materials and Methods: We retrospectively reviewed 240 patients (505 tumors) who had undergone radical cystectomy. The tumors were classified as follows: superficial or invasive tumors indicated by the stalk or inchworm sign on 3.0 Tesla MRI. We evaluated the diagnostic accuracy of the stalk and inchworm signs, by comparing each finding with the postoperative pathologic T stage. We compared diagnostic performance between them statistically. Results: The stalk and inchworm signs showed high specificity (93% and 91%, respectively), positive predictive values (89% and 90%, respectively), and acceptable accuracy (70% and 74%, respectively), but low sensitivity (54% and 61%, respectively) and negative predictive values (60% and 63%, respectively). There was no statistically significant difference between the two signs (p > 0.05). Conclusion: Superficial bladder cancers could be differentiated from invasive tumors using the stalk or inchworm sign on MRI.

Changes in Cortical Auditory Evoked Potentials by Ipsilateral, Contralateral and Binaural Speech Stimulation in Normal-Hearing Adults.

OBJECTIVES: Cortical auditory evoked potentials (CAEPs) have been used to examine auditory cortical development or changes in patients with hearing loss. However, there have been no studies analyzing CAEP responses to the different sound stimulation by different stimulation sides. We characterized changes in normal CAEP responses by stimulation sides in normal-hearing adults. METHODS: CAEPs from the right auditory cortex were recorded in 16 adults following unilateral (ipsilateral and contralateral) and bilateral sound stimulation using three speech sounds (/m/, /g/, and /t/). Amplitudes and latencies of the CAEP peaks in three conditions were compared. RESULTS: Contralateral stimulation elicited larger P2-N1 amplitudes (sum of P2 and N1 amplitudes) than ipsilateral stimulation regardless of the stimulation sounds, mostly due to the larger P2 amplitudes obtained, but elicited comparable P2-N1 amplitudes to bilateral stimulation. Although the P2-N1 amplitudes obtained with the three speech sounds were comparable following contralateral stimulation, the /m/ sound elicited the largest P2-N1 amplitude in ipsilateral stimulation condition due to the largest N1 amplitude obtained, whereas /t/ elicited larger a P2-N1 amplitude than /g/ in bilateral stimulation condition due to a larger P2 amplitude. CONCLUSION: Spectrally different speech sounds and input sides are encoded differently at the cortical level in normal-hearing adults. Standardized speech stimuli, as well as specific input sides of speech, are needed to examine normal development or rehabilitation-related changes of the auditory cortex in the future.