Functional Characterization of Circadian Nuclear Receptors REV-ERBα and REV-ERBß in Human Osteosarcoma Cell Cultures.

REV-ERBα and its paralog, REV-ERBß, encoded by NR1D1 and NR1D2 genes, are key nuclear receptors that link the circadian timing system and metabolic homeostasis. Since heme is an endogenous ligand, REV-ERBs have been considered key components of the circadian molecular clock and can be pharmacologically targeted to treat various circadian rhythm-related diseases, such as cardiometabolic, inflammatory, and neuropsychiatric diseases, as well as cancer. REV-ERBs are believed to be functionally redundant and compensatory, although they often affect the expression of gene subsets in an isoform-specific manner. Therefore, this study aimed to identify the redundant and distinct roles of each isoform in controlling its target genes by comparing the transcriptome profiles of a panel of mutant U2OS human osteosarcoma cells in which either NR1D1 or NR1D2 was ablated. Indeed, our transcriptomic analyses revealed that most REV-ERB-regulated genes are controlled by redundant or even additive actions. However, the RNA expression profiles of each single mutant cell line also provide strong evidence for isoform-dependent actions. For example, REV-ERBα is more responsible for regulating the NF-κΒ signaling pathway, whereas a group of extracellular matrix components requires REV-ERBß to maintain their expression. We found that REV-ERBs have isoform-selective functions in the regulation of certain circadian output pathways despite their overlapping roles in the circadian molecular clock. Thus, the development of isoform-selective REV-ERB modulators can help treat metabolic disturbances and certain types of cancer.

A subfamily of the small heat shock proteins of the marine red alga Neopyropia yezoensis localizes in the chloroplast.

Small heat shock proteins (sHSPs) play a crucial role under abiotic stress and are present in all organisms, from eukaryotes to prokaryotes. However, studies on the sHSP gene family in red alga are limited. In this study, we aimed to identify and characterize NysHSP genes from the genome of N. yezoensis, a marine red alga adapted to the stressful intertidal zone. We identified seven NysHSP genes distributed on all three chromosomes. Expression analysis revealed that all NysHSP genes responded to H2O2 and heat stress in the gametophytic thalli, but these genes responded only to heat stress in the sporophytic conchocelis. NysHSP20.3, which has an acidic isoelectric point (pI) and short N-terminal region, was localized as granules in the cytosol. Fluorescence imaging of the NysHSP25.8-GFP and NysHSP28.4-GFP fusion proteins revealed that these proteins were located in the chloroplast. Based on their characteristics and cellular localization, the NysHSPs are divided into two subfamilies. Subfamily I includes four sHSP genes that strongly respond to heat stress and encode a protein localized in the cytosol. The NysHSP gene of subfamily II encodes a polypeptide with a long N-terminal region located in the chloroplast. This study provides insights into the evolution and function of the sHSP gene family of the marine red alga N. yezoensis and how it adapts to the stressful intertidal zone.

Cancer Prediction With Machine Learning of Thrombi From Thrombectomy in Stroke: Multicenter Development and Validation.

BACKGROUND: We aimed to develop and validate machine learning models to diagnose patients with ischemic stroke with cancer through the analysis of histopathologic images of thrombi obtained during endovascular thrombectomy. METHODS: This was a retrospective study using a prospective multicenter registry which enrolled consecutive patients with acute ischemic stroke from South Korea who underwent endovascular thrombectomy. This study included patients admitted between July 1, 2017 and December 31, 2021 from 6 academic university hospitals. Whole-slide scanning was performed for immunohistochemically stained thrombi. Machine learning models were developed using transfer learning with image slices as input to classify patients into 2 groups: cancer group or other determined cause group. The models were developed and internally validated using thrombi from patients of the primary center, and external validation was conducted in 5 centers. The model was also applied to patients with hidden cancer who were diagnosed with cancer within 1 month of their index stroke. RESULTS: The study included 70 561 images from 182 patients in both internal and external datasets (119 patients in internal and 63 in external). Machine learning models were developed for each immunohistochemical staining using antibodies against platelets, fibrin, and erythrocytes. The platelet model demonstrated consistently high accuracy in classifying patients with cancer, with area under the receiver operating characteristic curve of 0.986 (95% CI, 0.983-0.989) during training, 0.954 (95% CI, 0.937-0.972) during internal validation, and 0.949 (95% CI, 0.891-1.000) during external validation. When applied to patients with occult cancer, the model accurately predicted the presence of cancer with high probabilities ranging from 88.5% to 99.2%. CONCLUSIONS: Machine learning models may be used for prediction of cancer as the underlying cause or detection of occult cancer, using platelet-stained immunohistochemical slide images of thrombi obtained during endovascular thrombectomy.

Overexpression of S-Adenosylmethionine Synthetase in Recombinant Chlamydomonas for Enhanced Lipid Production.

Microalgae are attracting much attention as promising, eco-friendly producers of bioenergy due to their fast growth, absorption of carbon dioxide from the atmosphere, and production capacity in wastewater and salt water. However, microalgae can only accumulate large quantities of lipid in abiotic stress, which reduces productivity by decreasing cell growth. In this study, the strategy was investigated to increase cell viability and lipid production by overexpressing S-adenosylmethionine (SAM) synthetase (SAMS) in the microalga Chlamydomonas reinhardtii. SAM is a substance that plays an important role in various intracellular biochemical reactions, such as cell proliferation and stress response, and the overexpression of SAMS could allow cells to withstand the abiotic stress and increase productivity. Compared to wild-type C. reinhardtii, recombinant cells overexpressing SAMS grew 1.56-fold faster and produced 1.51-fold more lipids in a nitrogen-depleted medium. Furthermore, under saline-stress conditions, the survival rate and lipid accumulation were 1.56 and 2.04 times higher in the SAMS-overexpressing strain, respectively. These results suggest that the overexpression of SAMS in recombinant C. reinhardtii has high potential in the industrial-scale production of biofuels and various other high-value-added materials.

Short-Term Event Prediction in the Operating Room (STEP-OP) of Five-Minute Intraoperative Hypotension Using Hybrid Deep Learning: Retrospective Observational Study and Model Development.

BACKGROUND: Intraoperative hypotension has an adverse impact on postoperative outcomes. However, it is difficult to predict and treat intraoperative hypotension in advance according to individual clinical parameters. OBJECTIVE: The aim of this study was to develop a prediction model to forecast 5-minute intraoperative hypotension based on the weighted average ensemble of individual neural networks, utilizing the biosignals recorded during noncardiac surgery. METHODS: In this retrospective observational study, arterial waveforms were recorded during noncardiac operations performed between August 2016 and December 2019, at Seoul National University Hospital, Seoul, South Korea. We analyzed the arterial waveforms from the big data in the VitalDB repository of electronic health records. We defined 2s hypotension as the moving average of arterial pressure under 65 mmHg for 2 seconds, and intraoperative hypotensive events were defined when the 2s hypotension lasted for at least 60 seconds. We developed an artificial intelligence-enabled process, named short-term event prediction in the operating room (STEP-OP), for predicting short-term intraoperative hypotension. RESULTS: The study was performed on 18,813 subjects undergoing noncardiac surgeries. Deep-learning algorithms (convolutional neural network [CNN] and recurrent neural network [RNN]) using raw waveforms as input showed greater area under the precision-recall curve (AUPRC) scores (0.698, 95% CI 0.690-0.705 and 0.706, 95% CI 0.698-0.715, respectively) than that of the logistic regression algorithm (0.673, 95% CI 0.665-0.682). STEP-OP performed better and had greater AUPRC values than those of the RNN and CNN algorithms (0.716, 95% CI 0.708-0.723). CONCLUSIONS: We developed STEP-OP as a weighted average of deep-learning models. STEP-OP predicts intraoperative hypotension more accurately than the CNN, RNN, and logistic regression models. TRIAL REGISTRATION: ClinicalTrials.gov NCT02914444; https://clinicaltrials.gov/ct2/show/NCT02914444.

Antitussive effect of a magnesium infusion during anesthetic emergence in patients with double-lumen endotracheal tube: a randomized controlled trial.

BACKGROUND: A double-lumen endotracheal tube (DLT) inserted into the bronchus can stimulate the respiratory tracts, causing coughing. Opioids have been introduced to prevent emergence cough. However, the administration of a significant opioid dose at the end of surgery may result in undesirable events. Magnesium, common intracellular ion, suppress bronchial smooth muscle contraction and have antitussive effect. We investigated the antitussive effects of a magnesium infusion during anesthetic emergence in patients who underwent thoracic surgery requiring one-lung ventilation (OLV) anesthesia with a DLT. METHODS: One-hundred forty patients undergoing OLV anesthesia with a DLT were enrolled in this prospective, randomized double-blinded trial. In combination with a low dose of remifentanil, patients were randomly allocated to receive either magnesium sulphate (infusion of 15 mg/kg/hour after a single bolus of 30 mg/kg) or normal saline during the operation and emergence. Primary outcomes were the severity and incidence of cough during emergence. RESULTS: The severity of cough was assessed by the cough severity grading score: 0, no cough; 1, single cough; 2, cough persistence <5 seconds; 3, cough persistence ≥5 seconds. There was a significant difference in the severity score of cough between the groups [median (IQR): 2 (0 to 3) in control group vs. 0 (0 to 1) in magnesium group, P=0.003]. However, there was no significant difference in the overall incidence of cough between both groups [42 (64.6%) in control group vs. 31 (47.7%) in magnesium group, P=0.077]. CONCLUSIONS: Magnesium attenuated the severity of cough during emergence after OLV anesthesia using a DLT without adverse events.

Persistent STAT5 activation reprograms the epigenetic landscape in CD4+ T cells to drive polyfunctionality and antitumor immunity.

The presence of polyfunctional CD4+ T cells is often associated with favorable antitumor immunity. We report here that persistent activation of signal transducer and activator of transcription 5 (STAT5) in tumor-specific CD4+ T cells drives the development of polyfunctional T cells. We showed that ectopic expression of a constitutively active form of murine STAT5A (CASTAT5) enabled tumor-specific CD4+ T cells to undergo robust expansion, infiltrate tumors vigorously, and elicit antitumor CD8+ T cell responses in a CD4+ T cell adoptive transfer model system. Integrated epigenomic and transcriptomic analysis revealed that CASTAT5 induced genome-wide chromatin remodeling in CD4+ T cells and established a distinct epigenetic and transcriptional landscape. Single-cell RNA sequencing analysis further identified a subset of CASTAT5-transduced CD4+ T cells with a molecular signature indicative of progenitor polyfunctional T cells. The therapeutic significance of CASTAT5 came from our finding that adoptive transfer of T cells engineered to coexpress CD19-targeting chimeric antigen receptor (CAR) and CASTAT5 gave rise to polyfunctional CD4+ CAR T cells in a mouse B cell lymphoma model. The optimal therapeutic outcome was obtained when both CD4+ and CD8+ CAR T cells were transduced with CASTAT5, indicating that CASTAT5 facilitates productive CD4 help to CD8+ T cells. Furthermore, we provide evidence that CASTAT5 is functional in primary human CD4+ T cells, underscoring its potential clinical relevance. Our results implicate STAT5 as a valid candidate for T cell engineering to generate polyfunctional, exhaustion-resistant, and tumor-tropic antitumor CD4+ T cells to potentiate adoptive T cell therapy for cancer.

Gamma-irradiation degraded sulfated polysaccharide from a new red algal strain Pyropia yezoensis Sookwawon 104 with in vitro antiproliferative activity.

Pyropia yezoensis Sookwawon 104 is a newly cultivated strain of red marine algae. The present study aimed to investigate the in vitro antiproliferative activity of sulfated polysaccharide extracted from P. yezoensis Sookwawon 104 (PYSP), as well as that of its low molecular weight (Mw) derivatives. PYSP is a heterogeneous sulfated polysaccharide mainly composed of galactose, glucose and fucose. PYSP was degraded by gamma-irradiation at doses of 20 and 100 kGy to produce two derivatives, named as PYSP-20 and PYSP-100, respectively. Comparison of PYSP, PYSP-20 and PYSP-100 revealed clear differences in their molecular weight (Mw) distributions, and distinct in vitro antiproliferative activities against Hep3B, MDA-MB-231 and HeLa cancer cell lines. PYSP-20 and PYSP-100 exhibited stronger antiproliferative effects than PYSP, suggesting that the reduction in Mw may have increased the in vitro antiproliferative activity. Furthermore, the mRNA expression levels of the antitumor gene P53 and cell cycle-associated genes P21, Cyclin B1 and cyclin dependent kinase 1 (Cdk1) were further analyzed by reverse transcription-quantitative PCR in PYSP-20 and PYSP-100-treated cancer cells. PYSP and its derivatives were shown to inhibit the proliferation of tumor cells by regulating the expression of P53, P21, Cyclin B1 and Cdk1. In conclusion, low-Mw polysaccharide derivatives prepared from P. yezoensis Sookwawon 104 by gamma-irradiation exhibit significant inhibition effects on cancer cell proliferation in vitro and may be a novel source of potential anticancer therapeutic agents.

Predicting Cardiac Arrest and Respiratory Failure Using Feasible Artificial Intelligence with Simple Trajectories of Patient Data.

We introduce a Feasible Artificial Intelligence with Simple Trajectories for Predicting Adverse Catastrophic Events (FAST-PACE) solution for preparing immediate intervention in emergency situations. FAST-PACE utilizes a concise set of collected features to construct an artificial intelligence model that predicts the onset of cardiac arrest or acute respiratory failure from 1 h to 6 h prior to its occurrence. Data from the trajectory of 29,181 patients in intensive care units of two hospitals includes periodic vital signs, a history of treatment, current health status, and recent surgery. It excludes the results of laboratory data to construct a feasible application in wards, out-hospital emergency care, emergency transport, or other clinical situations where instant medical decisions are required with restricted patient data. These results are superior to previous warning scores including the Modified Early Warning Score (MEWS) and the National Early Warning Score (NEWS). The primary outcome was the feasibility of an artificial intelligence (AI) model predicting adverse events 1 h to 6 h prior to occurrence without lab data; the area under the receiver operating characteristic curve of this model was 0.886 for cardiac arrest and 0.869 for respiratory failure 6 h before occurrence. The secondary outcome was the superior prediction performance to MEWS (net reclassification improvement of 0.507 for predicting cardiac arrest and 0.341 for predicting respiratory failure) and NEWS (net reclassification improvement of 0.412 for predicting cardiac arrest and 0.215 for predicting respiratory failure) 6 h before occurrence. This study suggests that AI consisting of simple vital signs and a brief interview could predict a cardiac arrest or acute respiratory failure 6 h earlier.

Identifying predictors for postoperative clinical outcome in lumbar spinal stenosis patients using smart-shoe technology.

BACKGROUND: Approximately 33% of the patients with lumbar spinal stenosis (LSS) who undergo surgery are not satisfied with their postoperative clinical outcomes. Therefore, identifying predictors for postoperative outcome and groups of patients who will benefit from the surgical intervention is of significant clinical benefit. However, many of the studied predictors to date suffer from subjective recall bias, lack fine digital measures, and yield poor correlation to outcomes. METHODS: This study utilized smart-shoes to capture gait parameters extracted preoperatively during a 10 m self-paced walking test, which was hypothesized to provide objective, digital measurements regarding the level of gait impairment caused by LSS symptoms, with the goal of predicting postoperative outcomes in a cohort of LSS patients who received lumbar decompression and/or fusion surgery. The Oswestry Disability Index (ODI) and predominant pain level measured via the Visual Analogue Scale (VAS) were used as the postoperative clinical outcome variables. RESULTS: The gait parameters extracted from the smart-shoes made statistically significant predictions of the postoperative improvement in ODI (RMSE =0.13, r=0.93, and p<3.92×10-7) and predominant pain level (RMSE =0.19, r=0.83, and p<1.28×10-4). Additionally, the gait parameters produced greater prediction accuracy compared to the clinical variables that had been previously investigated. CONCLUSIONS: The reported results herein support the hypothesis that the measurement of gait characteristics by our smart-shoe system can provide accurate predictions of the surgical outcomes, assisting clinicians in identifying which LSS patient population can benefit from the surgical intervention and optimize treatment strategies.

Transcriptome-Based Identification of the Desiccation Response Genes in Marine Red Algae Pyropia tenera (Rhodophyta) and Enhancement of Abiotic Stress Tolerance by PtDRG2 in Chlamydomonas.

Pyropia tenera (Kjellman) are marine red algae that grow in the intertidal zone and lose more than 90% of water during hibernal low tides every day. In order to identify the desiccation response gene (DRG) in P. tenera, we generated 1,444,210 transcriptome sequences using the 454-FLX platform from the gametophyte under control and desiccation conditions. De novo assembly of the transcriptome reads generated 13,170 contigs, covering about 12 Mbp. We selected 1160 differentially expressed genes (DEGs) in response to desiccation stress based on reads per kilobase per million reads (RPKM) expression values. As shown in green higher plants, DEGs under desiccation are composed of two groups of genes for gene regulation networks and functional proteins for carbohydrate metabolism, membrane perturbation, compatible solutes, and specific proteins similar to higher plants. DEGs that show no significant homology with known sequences in public databases were selected as DRGs in P. tenera. PtDRG2 encodes a novel polypeptide of 159 amino acid residues locating chloroplast. When PtDRG2 was overexpressed in Chlamydomonas, the PtDRG2 confer mannitol and salt tolerance in transgenic cells. These results suggest that Pyropia may possess novel genes that differ from green plants, although the desiccation tolerance mechanism in red algae is similar to those of higher green plants. These transcriptome sequences will facilitate future studies to understand the common processes and novel mechanisms involved in desiccation stress tolerance in red algae.

Timely Interventions can Increase Smoking Cessation Rate in Men with Ischemic Stroke.

PURPOSE: Smoking cessation is strongly recommended for every smoker after ischemic stroke, but many patients fail to quit smoking. An improved smoking cessation rate has been reported with intensive behavioral therapy during hospitalization and supportive contact after discharge. The aim of this study was to demonstrate the usefulness of the timely interventions for smoking cessation in men with acute ischemic stroke. METHODS: Patients who participated in the timely interventions strategy (TI group) were compared with those who received conventional counseling (CC group). In the TI group, a certified nurse provided comprehensive education during admission and additional counseling after discharge. Outcome was measured by point smoking success rate and sustained smoking cessation rate for 12 months. RESULTS: Participants, 157 men (86 of the TI group and 71 of the CC group), were enrolled. Mean age was 58.25 ± 11.23 years and mean initial National Institutes of Health Stroke Scale score was 4.68 ± 5.46. The TI group showed a higher point smoking success rate compared with the CC group (p= .003). Multiple logistic regression analysis showed that the TI group was 2.96-fold (95% CI, 1.43~6.13) more likely to sustain smoking cessation for 12 months than the CC group. CONCLUSION: Findings indicate that multiple interventions initiated during hospital stay and regular follow-up after discharge are more effective than conventional smoking cessation counseling in men with acute ischemic stroke.

EphrinA5-EphA7 complex induces apoptotic cell death via TNFR1.

A previous study showed that the EphA7 receptor regulates apoptotic cell death during early brain development. In this study, we provide evidence that the EphA7 receptor interacts with death receptors such as tumor necrosis factor receptor 1 (TNFR1) to decrease cell viability. We showed that ephrinA5 stimulates EphA7 to activate the TNFR1-mediated apoptotic signaling pathway. In addition, a pull-down assay using biotinylated ephrinA5-Fc revealed that ephrinA5-EphA7 complexes recruit TNFR1 to form a multi-protein complex. Immunocytochemical staining analysis showed that EphA7 was co-localized with TNFR1 on the cell surface when cells were incubated with ephrinA5 at low temperatures. Finally, both the internalization motif and death domain of TNFR1 was important for interacting with an intracytoplasmic region of EphA7; this interaction was essential for inducing the apoptotic signaling cascade. This result suggests that a distinct multi-protein complex comprising ephrinA5, EphA7, and TNFR1 may constitute a platform for inducing caspase-dependent apoptotic cell death.

IDENTIFICATION OF THE HIGH-TEMPERATURE RESPONSE GENES FROM PORPHYRA SERIATA (RHODOPHYTA) EXPRESSION SEQUENCE TAGS AND ENHANCEMENT OF HEAT TOLERANCE OF CHLAMYDOMONAS (CHLOROPHYTA) BY EXPRESSION OF THE PORPHYRA HTR2 GENE(1).

Temperature is one of the major environmental factors that affect the distribution, growth rate, and life cycle of intertidal organisms, including red algae. In an effort to identify the genes involved in the high-temperature tolerance of Porphyra, we generated 3,979 expression sequence tags (ESTs) from gametophyte thalli of P. seriata Kjellm. under normal growth conditions and high-temperature conditions. A comparison of the ESTs from two cDNA libraries allowed us to identify the high temperature response (HTR) genes, which are induced or up-regulated as the result of high-temperature treatment. Among the HTRs, HTR2 encodes for a small polypeptide consisting of 144 amino acids, which is a noble nuclear protein. Chlamydomonas expressing the Porphyra HTR2 gene shows higher survival and growth rates than the wild-type strain after high-temperature treatment. These results suggest that HTR2 may be relevant to the tolerance of high-temperature stress conditions, and this Porphyra EST data set will provide important genetic information for studies of the molecular basis of high-temperature tolerance in marine algae, as well as in Porphyra.

The SAM domains of Anks family proteins are critically involved in modulating the degradation of EphA receptors.

We recently reported that the phosphotyrosine-binding (PTB) domain of Anks family proteins binds to EphA8, thereby positively regulating EphA8-mediated signaling pathways. In the current study, we identified a potential role for the SAM domains of Anks family proteins in EphA signaling. We found that SAM domains of Anks family proteins directly bind to ubiquitin, suggesting that Anks proteins regulate the degradation of ubiquitinated EphA receptors. Consistent with the role of Cbl ubiquitin ligases in the degradation of Eph receptors, our results revealed that the ubiquitin ligase c-Cbl induced the ubiquitination and degradation of EphA8 upon ligand binding. Ubiquitinated EphA8 also bound to the SAM domains of Odin, a member of the Anks family proteins. More importantly, the overexpression of wild-type Odin protected EphA8 and EphA2 from undergoing degradation following ligand stimulation and promoted EphA-mediated inhibition of cell migration. In contrast, a SAM domain deletion mutant of Odin strongly impaired the function of endogenous Odin, suggesting that the mutant functions in a dominant-negative manner. An analysis of Odin-deficient primary embryonic fibroblasts indicated that Odin levels play a critical role in regulating the stability of EphA2 in response to ligand stimulation. Taken together, our studies suggest that the SAM domains of Anks family proteins play a pivotal role in enhancing the stability of EphA receptors by modulating the ubiquitination process.

Regulatory effects of cytokine production in atopic allergic reaction by gammi-danguieumja.

Gammi-danguieumja (GD) is clinically used in South Korea for treating atopic dermatitis. However, its effects in experimental models remain unknown. We investigated a possible effect of GD on cytokines production using human T cell line (MOLT-4) or human mast cell line. As a result, GD (0.01 mg/mL)-containing medium in stimulated culture supernatants increased IL-2 and IFN-gamma, and decreased IL-4 secretion in MOLT-4. GD (0.01-1 mg/mL)-containing medium in stimulated culture supernatants dose-dependently and significantly decreased IL-8, IL-13, and tumor necrosis factor-alpha secretion on the phorbol 12-myristate 13-acetate and A23187-stimulated HMC-1. In addition, GD inhibited histamine release from activated mast cells. These results suggest that GD contributes to the regulation of atopic allergic reactions.

Immune-enhancement effect of the herbal combination Allergina.

BACKGROUND: The herbal formulation, Allergina, has long been used for various diseases. It is known to have an anti-microbial and anti-virus activity. However, it is still unclear how Allergina has these effects in experimental models. We investigated the effect of Allergina on the proliferation of T cell and production of cytokines in human T-cell line, MOLT-4 cells, and mouse peritoneal macrophages. METHODS: The MOLT-4 cells were cultured for 24 h in the presence or absence of Allergina. Allergina significantly increased the cell viability by 26.9+/-5.4% (P<0.05) and interleukin (IL)-2, IL-4 and interferon (IFN)-gamma production compared with media control (about 4-fold for IL-2, 2.5-fold for IL-4 and 3.4-fold for IFN-gamma, P<0.05). Maximal effective concentration of Allergina was 1 mg/ml for IL-2 and, 0.01 mg/ml for IL-4 and IFN-gamma. Allergina alone or Allergina plus recombinant IFN-gamma (rIFN-gamma) increased the production of tumor necrosis factor (TNF)-alpha, but Allergina decreased the production of TNF-alpha on rIFN-gamma plus LPS-stimulated macrophages. In addition, Allergina increased the production of IL-12 on mouse peritoneal macrophages and peripheral blood mononuclear cells. CONCLUSION: Allergina may have an immune-enhancement effect through the cytokine production.

Effects of Allergina on the treatment of otitis media with effusions.

The number of pediatric patients with recurrent otitis media with effusions (ROMEs) is increasing because of the frequency of recurrence. The herbal combination Allergina is used for inflammatory-disease treatment in the Republic of Korea; in our study, the patients with ROME were treated with either Allergina (11 ears) or antibiotics (13 ears). We analyzed the levels of cytokines in middle-ear effusions (MEEs) and compared these levels in the Allergina-treated patients with those in the antibiotics-treated patients. The mean levels of interleukin (IL)-2 and IL-4 in MEEs were significantly higher in the Allergina-treated patients than in the antibiotics-treated patients, whereas levels of IL-1beta, IL-6, IL-8, and tumor necrosis factor (TNF)-alpha in MEEs were significantly lower in the Allergina-treated patients than in the antibiotics-treated patients. Clinical signs of ROME disappeared markedly after all the patients were given an oral administration of Allergina. Our experimental studies provide evidence that Allergina may be beneficial in the treatment of ROME by regulating cytokine production.