Clinical characteristics of the "Gap" between the prevalence and incidence of hearing loss using National Health Insurance Service data.

OBJECTIVES: Hearing loss is the inability to hear speech or sounds well, owing to a number of causes. This study aimed to simultaneously determine the prevalence, incidence, and the Gap between them in hearing loss in South Korean patients at the same point in time as well as to identify patients who have not recovered from hearing loss. METHODS: We examined the prevalence and incidence of patients diagnosed with hearing loss in the National Health Insurance Service database over an 11-year period from 2010 to 2020. The difference between the prevalence and the incidence was defined in this study as the term "Gap". Gap is the number of patients converted into the number of patients per 100,000 people by subtracting the incidence from the prevalence. Clinical characteristics such as sex and age per 100,000 individuals were examined. RESULTS: As of 2020, the domestic prevalence obtained in this study was 1.84%, increasing annually, and the prevalence increased with age to 4.10% among those over 60. The domestic incidence was 1.57%, increasing annually, and the incidence increased with age to 3.36% for those over 60s. The Gap was 0.27%, showing a steady increase from 2011 to 2020 with a corresponding increase in insurance benefit expenses. CONCLUSION: To fully understand the burden of hearing loss and develop effective prevention and treatment strategies, it is important to measure the Gap between its prevalence and incidence. This Gap means a lot because hearing loss is an irreversible disease. Gap represents patients who have already been diagnosed with hearing loss and are being diagnosed every year, indicating that the number of patients who do not recover is increasing. In other words, the increase in Gap meant that there were many patients who constantly visited the hospital for diagnosis of hearing loss.

Vitamin D supplementation in preventing the recurrence of benign paroxysmal positional vertigo.

Objective: To evaluate the effect of vitamin D supplementation on the recurrence rate of benign paroxysmal positional vertigo (BPPV). Methods: A single-center, prospective, double-blind, placebo-controlled, parallel-group randomized controlled trial was conducted between November 2018 and May 2020. After successful treatment with canalith repositioning maneuvers, patients diagnosed with BPPV were randomized to either the vitamin D (n = 20) or placebo (n = 18) group. Only patients with serum vitamin D levels <20 ng mL-1 were included. The vitamin D group received 7000 IU of vitamin D weekly for a year, while the placebo group received a matching placebo drug. The final endpoint was the BPPV recurrence rate and correlation with serum vitamin D levels after 6 and 12 months in both groups. Results: Among 38 patients, 37 were followed up for 6 months and 30 for 12 months. Significantly higher serum vitamin D levels were observed in the vitamin D group compared to the placebo group at both the 6-month and 1-year follow-ups (p < .001 at each timepoint). The recurrence rate was lower in the vitamin D group than in the placebo group after 6 months (p = .008) and 1 year (p = .003). Conclusion: Vitamin D supplementation, in the absence of calcium, may be beneficial for patients prone to recurrent BPPV episodes, particularly when serum vitamin D levels are suboptimal (PRE20181024-001, Clinical Research Information Service, South Korea). Level of Evidence: 1b.

Combination Therapy of Choline Alfoscerate With Ginkgo biloba Monotherapy in Age-Related Hearing Loss: Effects and Outcomes.

BACKGROUND AND OBJECTIVES: Ginkgo biloba and choline alfoscerate are used as adjuvant treatment for presbycusis, but studies on how the monotherapy differs from the combination therapy are lacking. Therefore, this study aimed to compare the audiologic outcomes between Ginkgo biloba monotherapy and Ginkgo biloba and choline alfoscerate combination therapy. Subjects and. METHODS: The study groups are divided into three: negative control, monotherapy, and combination therapy groups. All groups' pure tone audiometry was measured by dividing the study period into Initial, 3-6, 6-9, 9-12, 12-15 months, and checked whether differences between groups were present. RESULTS: The combination therapy showed less gradient gap than the monotherapy, indicating less hearing loss rate than the monotherapy. Based on the Kaplan-Meier curve, the combination therapy showed better results in terms of survival time of hearing. CONCLUSIONS: As a pharmacological treatment for presbycusis, combination therapy shows better results than monotherapy.

Assessment of Disease Severity and Quality of Life in Patients with Atopic Dermatitis from South Korea.

BACKGROUND: Data illustrating the impact of atopic dermatitis (AD) on lives of adults with AD in South Korea are limited. OBJECTIVE: To assess the AD disease severity and its impact on quality of life (QoL) in patients with AD from South Korea. METHODS: Patients with AD utilizing the specialist dermatology services of major hospitals in South Korea were assessed for disease severity using Eczema Area and Severity Index (EASI) score, for QoL using Dermatology Life Quality Index (DLQI) (for QoL), and for comorbidities and treatment experience via retrospective review of 12-month medical records. Clinical and sociodemographic characteristics were also measured. RESULTS: Of the 1,163 patients, 695 (59.8%) were men (mean age [years]±standard deviation: 31.6±12.1). Overall, 52.9% (n=615) patients had moderate-to-severe disease (EASI>7). The QoL of 72.3% (n=840) patients was affected moderately-to-severely (DLQI score: 6~30). Systemic immunosuppressants were used ≥1 over past 12 months in 51.9% (n=603) patients, and the most commonly used were cyclosporines (45.7%, n=531) and systemic corticosteroids (40.5%, n=471). Approximately, 10.8% (n=126) patients consulted or received treatment for AD-related eye problem. Of these, 40% (n=50) patients reported poor, very poor, or completely blind status; approximately, 16.7% patients (n=192) reported having depression or anxiety; and 35.5% (n=410) reported suicidal ideation or suicidal attempt. CONCLUSION: A large proportion of patients had moderate-to-severe AD, a compromised QoL, and ocular or mental health comorbidities, indicating a high disease burden despite systemic treatment. These findings highlight the importance of a holistic approach for the evaluation and treatment of patients with AD.

The Effectiveness of Hyperbaric Oxygen Therapy in Severe Idiopathic Sudden Sensorineural Hearing Loss.

OBJECTIVE: To evaluate the effect of combined hyperbaric oxygen therapy (HBOT) and steroid therapy in severe idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: Between January 2010 and July 2017, we evaluated 218 patients with ISSNHL and divided them into 2 groups: those with hearing loss greater than 80 dB and those with hearing loss of 60-79 dB. Each group was further divided into 3 groups according to the treatment method: oral steroids alone (PO), PO+intratympanic injection (IT), and PO+IT+HBOT. The treatment effect was evaluated for improvement in hearing thresholds at mid-term (3 weeks later) and final term (2 months later). RESULTS: When comparing the 3 treatment groups within the group that had a hearing loss greater than 80 dB, no differences were observed in the gaps in hearing thresholds and in the duration of improvement (P = .0764 and .2938, respectively). However, in the group with 60-79 dB hearing loss, the gaps in hearing thresholds at mid-term were 27.50 dB in the PO group, 38.13 dB in the PO+IT group, and 51.25 dB in the PO+IT+HBOT group. The treatment was more effective and faster in the initial period in the PO+IT+HBOT group than in the other groups. In addition, the results of frequency analysis showed greatest treatment efficacy at low frequencies of hearing. CONCLUSION: Patients with ISSNHL above 80 dB are less likely to recover hearing even after PO+IT+HBOT. However, this treatment initially accelerates recovery in patients with a hearing loss below 80 dB. Therefore, the appropriate indication for HBOT benefits in patients with severe or profound ISSNHL should be reviewed.

Usefulness of vertebrobasilar artery radiological finding as a predictive and prognostic factor for sudden sensorineural hearing loss.

OBJECTIVE: The association between sudden sensorineural hearing loss (SSNHL) and radiological findings of the vertebrobasilar artery is not well-known and little research has been done. We hypothesized that the radiological features of the vertebrobasilar artery contribute to the incidence and prognosis of SSNHL. METHODS: We retrospectively enrolled patients diagnosed with unilateral SSNHL (SSNHL group) and those with acute vestibular neuritis (AVN; control group) in our hospital. All patients underwent magnetic resonance imaging and computed tomography. We measured the following parameters on the radiological images: basilar artery diameter, direction and distance of basilar artery deviation, direction and distance of vertebral artery deviation, and incidence of vertebral artery obstruction. Pure tone audiometry (PTA) was performed in all patients. Follow up PTA between 1 week and 1 month after treatment was performed in the SSNHL group. RESULTS: A total of 244 SSNHL patients and 62 AVN patients were included in the analysis. Age, body mass index, and basilar artery diameter were found to be significantly associated with SSNHL. In the SSNHL group, patients were divided into three subgroups based on the consistency between the basilar artery deviation site and disease site. No significant difference was noted in initial PTA, final PTA, PTA recovery, and symptom improvement among the three groups. In case of the basilar artery, when the deviation and disease sites were in the opposite direction and the basilar artery diameter was >3.5 mm, diameter of basilar artery was positively correlated with PTA recovery. CONCLUSIONS: The strength of this study is that radiological evaluation of the vertebrobasilar artery was performed. Further research on the association between SSNHL and radiological features of the vertebrobasilar artery should be conducted to emphasize the importance of vascular assessment in SSNHL.

Comparison of Vitamin D Levels in Patients with and without Acne: A Case-Control Study Combined with a Randomized Controlled Trial.

BACKGROUND: Vitamin D plays an important role in the immune system, and its deficiency has been implicated in various skin diseases, including atopic dermatitis and psoriasis. Acne is a common inflammatory skin disease; however, the association with vitamin D remains unclear. OBJECTIVES: We evaluated vitamin D levels in patients with acne to determine the effect of vitamin D supplementation. METHODS: This study included 80 patients with acne and 80 healthy controls. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured, and demographic data were collected. Vitamin D-deficient patients were treated with oral cholecalciferol at 1000 IU/day for 2 months. RESULTS: Deficiency in 25(OH)D was detected in 48.8% of patients with acne, but in only 22.5% of the healthy controls. The level of 25(OH)D was inversely associated with the severity of acne, and there was a significant negative correlation with inflammatory lesions. In a subsequent trial, improvement in inflammatory lesions was noted after supplementation with vitamin D in 39 acne patients with 25(OH)D deficiency. LIMITATIONS: Limitations of the study include the small number of patients in the supplementation study and the natural fluctuation of acne. CONCLUSIONS: Vitamin D deficiency was more frequent in patients with acne, and serum 25(OH)D levels were inversely correlated with acne severity, especially in patients with inflammatory lesions.

Inhibitory effect of imperatorin on insulin-like growth factor-1-induced sebum production in human sebocytes cultured in vitro.

AIMS: Acne is a common skin disease that originates in the sebaceous gland. The pathogenesis of acne is very complex, involving the increase of sebum production and perifollicular inflammation. In this study, we screened the anti-lipogenic material and demonstrated its effect using cultured human sebocytes. MAIN METHODS: Normal human sebocytes were cultured by explanting the sebaceous glands. To evaluate the anti-lipogenic effect, sebocytes were treated with test materials and (14)C-acetate incorporation assay was performed. KEY FINDINGS: To screen the anti-lipogenic materials, we tested the effect of many herbal plant extracts. We found that Angelica dahurica extract inhibited the insulin-like growth factor-1 (IGF-1)-induced sebum production in terms of squalene synthesis in sebocytes. Furthermore, imperatorin isolated from A. dahurica showed remarkable inhibitory effect on squalene production as well as squalene synthase promoter activity. To investigate the putative action mechanism, we tested the effect of imperatorin on intracellular signaling. The results showed that imperatorin inhibited IGF-1-induced phosphorylation of Akt. In addition, imperatorin significantly down-regulated PPAR-γ and SREBP-1, the important transcription factors for lipid synthesis. SIGNIFICANCE: These results suggest that imperatorin has a potential for reducing sebum production in sebocytes, and can be applicable for acne treatment.

A low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminium garnet laser for the treatment of café-au-lait macules.

BACKGROUND: Café-au-lait macules (CALMs) are a common pigmentary disorder. Although a variety of laser modalities have been used to treat CALMs, their efficacies vary and dyspigmentation may develop. OBJECTIVE: We evaluated the clinical efficacy and safety of a low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser for the treatment of CALMs. METHODS: In a preliminary investigation, 6 patients underwent a split-lesion comparative study with 532- and 1064-nm Q-switched Nd:YAG laser treatment. In total, 32 patients with 39 CALMs were enrolled in a subsequent prospective trial to evaluate the treatment with a low-fluence 1064-nm Q-switched Nd:YAG laser. RESULTS: In the preliminary study, the 1064-nm treatment group had a more favorable response and a shorter recovery time. In a subsequent prospective trial of a 1064-nm laser, 74.4% of the lesions showed a clinical response with clearance of ≥50.0%. The treatment regimen was well tolerated; 15.4% of patients experienced adverse events. LIMITATIONS: The study participants were followed for 6 months, and there were no relevant treatment controls in the prospective trial group. CONCLUSION: Low-fluence 1064-nm Q-switched Nd:YAG laser therapy afforded good clinical improvement for treating CALMs.

Inhibitory effect of Paeonia lactiflora Pallas extract (PE) on poly (I:C)-induced immune response of epidermal keratinocytes.

Epidermal keratinocytes provide protective role against external stimuli by barrier formation. In addition, kertinocytes exerts their role as the defense cells via activation of innate immunity. Disturbance of keratinocyte functions is related with skin disorders. Psoriasis is a common skin disease related with inflammatory reaction in epidermal cells. We attempted to find therapeutics for psoriasis, and found that Paeonia lactiflora Pallas extract (PE) has an inhibitory potential on poly (I:C)-induced inflammation of keratinocytes. PE significantly inhibited poly (I:C)-induced expression of crucial psoriatic cytokines, such as IL-6, IL-8, CCL20 and TNF-α, via down-regulation of NF-κB signaling pathway in human keratinocytes. In addition, PE significantly inhibited poly (I:C)-induced inflammasome activation, in terms of IL-1ß and caspase-1 secretion. Finally, PE markedly inhibited poly (I:C)-increased NLRP3, an important component of inflammasome. These results indicate that PE has an inhibitory effect on poly (I:C)-induced inflammatory reaction of keratinocytes, suggesting that PE can be developed for the treatment of psoriasis.

Regulation of lipid production by light-emitting diodes in human sebocytes.

Light-emitting diodes (LED) have been used to treat acne vulgaris. However, the efficacy of LED on sebaceous lipid production in vitro has not been examined. This study investigated the efficacy of 415 nm blue light and 630 nm red light on lipid production in human sebocytes. When applied to human primary sebocytes, 415 nm blue light suppressed cell proliferation. Based on a lipogenesis study using Oil Red O, Nile red staining, and thin-layered chromatography, 630 nm red light strongly downregulated lipid production in sebocytes. These results suggest that 415 nm blue light and 630 nm red light influence lipid production in human sebocytes and have beneficial effects on acne by suppressing sebum production.

Can Platelet-rich Plasma Be Used for Skin Rejuvenation? Evaluation of Effects of Platelet-rich Plasma on Human Dermal Fibroblast.

BACKGROUND: Autologous platelet-rich plasma has attracted attention in various medical fields recently, including orthopedic, plastic, and dental surgeries and dermatology for its wound healing ability. Further, it has been used clinically in mesotherapy for skin rejuvenation. OBJECTIVE: In this study, the effects of activated platelet-rich plasma (aPRP) and activated platelet-poor plasma (aPPP) have been investigated on the remodelling of the extracellular matrix, a process that requires activation of dermal fibroblasts, which is essential for rejuvenation of aged skin. METHODS: Platelet-rich plasma (PRP) and platelet-poor plasma (PPP) were prepared using a double-spin method and then activated with thrombin and calcium chloride. The proliferative effects of aPRP and aPPP were measured by [(3)H]thymidine incorporation assay, and their effects on matrix protein synthesis were assessed by quantifying levels of procollagen type I carboxy-terminal peptide (PIP) by enzyme-linked immunosorbent assay (ELISA). The production of collagen and matrix metalloproteinases (MMP) was studied by Western blotting and reverse transcriptase-polymerase chain reaction. RESULTS: Platelet numbers in PRP increased to 9.4-fold over baseline values. aPRP and aPPP both stimulated cell proliferation, with peak proliferation occurring in cells grown in 5% aPRP. Levels of PIP were highest in cells grown in the presence of 5% aPRP. Additionally, aPRP and aPPP increased the expression of type I collagen, MMP-1 protein, and mRNA in human dermal fibroblasts. CONCLUSION: aPRP and aPPP promote tissue remodelling in aged skin and may be used as adjuvant treatment to lasers for skin rejuvenation in cosmetic dermatology.

Induction of connective tissue growth factor expression by sphingosylphosphorylcholine in cultured human skin fibroblasts.

Sphingosylphosphorylcholine (SPC) is a bioactive sphingolipid metabolite that can enhance wound healing. In an effort to find downstream effectors of SPC, we performed microarray analysis and found that the expression of the gene for connective tissue growth factor (CTGF) was significantly affected in human skin fibroblasts cultured in vitro. Northern blot analysis showed that SPC markedly induced CTGF mRNA expression in a dose- and time-dependent manner. Consistent with this result, Western blot analysis also showed that SPC significantly induced the CTGF production. Pretreatment with cycloheximide did not prevent the CTGF induction by SPC, indicating that SPC stimulates CTGF mRNA expression without the increased synthesis of a regulatory protein. Inhibition by pretreatment with Y27632, but not by PD98059 (a mitogen-activated protein kinase 1/2 inhibitor) and LY294002 (a phosphatidylinositol 3-kinase inhibitor), indicated that rho-kinase pathway was involved in SPC-induced CTGF expression. Together, these results reveal the potential importance of CTGF induction as a downstream event in SPC-induced cellular responses.

Inhibitory effects of Bombusae concretio Salicea on neuronal secretion of Alzheimer's beta-amyloid peptides, a neurodegenerative peptide.

Alzheimer's disease (AD) is characterized by the age-related deposition of beta-amyloid (A beta) 40/42 peptide aggregates in vulnerable brain regions. Multiple levels of evidence implicate a central role for A beta in the pathophysiology of AD. A beta is generated by the regulated cleavage of a = 700 amino acid A beta precursor protein (betaAPP). Full-length betaAPP can undergo proteolytic cleavage either within the A beta domain to generate secreted sbetaAPP alpha or at the N-terminal and C-terminal domain(s) of A beta to generate amyloidogenic A beta peptides. Several epidemiological studies have reported that estrogen replacement therapy protects against the development of AD in postmenopausal women. The aim of this study was to elucidate the antioxidant neuroprotective mechanism of Bombusae concretio Salicea (BC). BC was effective protectants against oxidative glutamate toxicity in the murine neuroblastoma cells (N2a) and human neuroblastoma cells (SK-N-MC). BC exhibited similar protective properties against oxidative glutamate toxicity and H2O2 toxicity. BC exhibited an antioxidant activity at approximately 20 microg/ml. BC of 5 microg/ml was ineffective in preventing the oxidative modification of LDL. The half-maximal effective concentration for BC was 16 microg/ml. These results suggested that BC supplementation in elderly men may be protective in the treatment of Alzheimer's disease (AD). We report here that treatment with BC increases the secretion of the nonamyloidogenic APP fragment, sbetaAPP alpha and decreases the secretion of A beta peptides from N2a cells and rat primary cerebrocortical neurons. These results raise the possibility that BC supplementation in elderly men may be protective in the treatment of AD.