Topical application of celastrol alleviates atopic dermatitis symptoms mediated through the regulation of thymic stromal lymphopoietin and group 2 innate lymphoid cells.

Atopic dermatitis is a chronic inflammatory skin disease, of which incidence is closely related to exposure to environmental pollutants and allergens. Thymic stromal lymphopoietin (TSLP) plays an important role in the early stages of atopic dermatitis development by inducing Th2 immune responses. In addition, TSLP regulates activation of group 2 innate lymphoid cells (ILC2), promoting the pathogenesis of atopic dermatitis. The aim of this study was to investigate whether celastrol alleviated atopic dermatitis symptoms by regulating TSLP expression and ILC2 stimulation. Celastrol suppressed TSLP production in mouse keratinocyte cells by inhibiting NF-ĸB activation. Topical application of celastrol significantly improved atopic dermatitis symptoms induced by house dust mite (HDM) in NC/Nga mice as determined by dermatitis score and histological assessment. Celastrol decreased the levels of TSLP in atopic dermatitis skin lesions of HDM-stimulated NC/Nga mice. Celastrol reduced levels of Th2 cytokines including IL-4, IL-5, and IL-13 in atopic dermatitis skin lesions of NC/Nga mice. Further, celastrol significantly reduced ILC2 population in atopic dermatitis skin lesions of NC/Nga mice. These results indicate that topical application of celastrol improved atopic dermatitis symptoms by lowering TSLP levels and concomitant immune responses. Data demonstrated that reduced TSLP levels and associated lower number of ILC2 cells alleviate atopic dermatitis symptoms induced by house dust mite.

Comparison of Two Different Treatment Protocols Using Systemic and Intratympanic Steroids with and without Hyperbaric Oxygen Therapy in Patients with Severe to Profound Idiopathic Sudden Sensorineural Hearing Loss: A Randomized Controlled Trial.

OBJECTIVES: This study aimed to investigate the efficacy of simultaneous steroid and hyperbaric oxygen therapy (HBOT) in patients with severe to profound idiopathic sudden sensorineural hearing loss (ISSNHL), which has a poor prognosis. METHODS: Sixty patients diagnosed with severe to profound ISSNHL (≥70 dB HL) were randomly divided into two groups in a prospective controlled trial: an oral steroid + intratympanic steroid injection (ITSI) group (control group) and an oral steroid + ITSI + HBOT group (study group). Pure-tone audiometry (PTA) results and word discrimination scores (WDS) were compared between the two groups before treatment and 10 days and 1, 2, and 3 months after treatment. Hearing improvement was assessed using the modified American Academy of Otolaryngology-Head and Neck Surgery criteria. Analyses were by both intention to treat and per protocol. RESULTS: A total of 58 patients completed the 3-month follow-up, and 2 patients in the study group were excluded due to follow-up loss in the per-protocol analysis. In the intention-to-treat and per-protocol analyses, the study group showed significantly better hearing levels than did the control group at 500 Hz (p < 0.05) 1 month after treatment and at 1 kHz (p < 0.05) 3 months after treatment. However, the average PTA values and PTA at 2, 4, and 8 kHz showed no significant difference. WDS improvement was significantly higher in the study group compared to the control group 3 months after treatment by both per-protocol (66.4 ± 13.3 and 56.7 ± 19.1%, respectively; p = 0.029) and intention-to-treat analyses (65.9 ± 14.1 and 56.7 ± 19.1%, respectively; p = 0.035). The sum of complete and partial hearing recovery for the study group was significantly higher than that for the control group by per-protocol analysis (60.7 vs. 33.3%; p = 0.037) and intention-to-treat analysis (60.0 vs. 33.3%; p = 0.038). CONCLUSION: These results demonstrate that the addition of HBOT to steroid combination therapy does not improve the average PTA values in severe to profound ISSNHL; however, it was associated with a better outcome at 500 Hz 1 month after treatment and, at 1 kHz, WDS 3 months after treatment. The sum of complete and partial hearing recovery was significantly higher for the study group than for the control group.

Substantiating the Therapeutic Effects of Simultaneous Heat Massage Combined with Conventional Physical Therapy for Treatment of Lower Back Pain: A Randomized Controlled Feasibility Trial.

BACKGROUND: There are various therapeutic options for the conservative management of lower back pain (LBP). A combination of two or more treatment options may be more effective in the clinical management of non-specific LBP. In this study, we compared the effects of simultaneous heat massage with conventional physical therapy in patients with subacute LBP. METHODS: A single-center randomized controlled trial in which 40 participants with LBP were allocated to one of two groups: a heat massage group (HMG) and physical therapy group (PTG). The HMG received simultaneous heat massage therapy using a mechanical device (CGM MB-1401, Ceragem, Republic of Korea). The PTG received conventional physical therapy. Both groups received 40 min of therapy once daily, five times a week, for a total of four weeks. Changes in serum cortisol, epinephrine (EP), and norepinephrine (NE) were assessed. The outcomes were measured using the pain numeric rating scale (PNRS), the Oswestry disability index (ODI), the Roland-Morris disability questionnaire (RMDQ), the short-form McGill pain questionnaire (SF-MPQ), the multidimensional fatigue inventory (MFI-20), the Beck depression inventory (BDI), surface EMG (sEMG), and sympathetic skin response (SSR) at baseline (PRE), at 2 (2 W) and 4 weeks (4 W) following the intervention. RESULTS: The serum EP and NE levels in the HMG decreased after treatment. The PNRS, ODI, RMDQ, and SF-MPQ scores improved without significance in both groups. The BDI score showed improvement in the HMG before the PTG. The MFI-20 score improved in both groups, but the results were better in the HMG than in the PTG at 4 W. All the activities of sEMG were significantly decreased in both groups. However, the improvement of the %MVIC in the HMG was better than that in the PTG at 4 W. The SSR latency on sEMG decreased while the amplitude increased in the HMG at 2 W and 4 W, respectively. CONCLUSIONS: Following 4 weeks of combined therapies, heat massage was not superior to conventional physical therapy alone. Both treatments were shown to be effective in improving LBP and pain-related disability. However, heat massage was shown to have a better effect on the control of autonomic nerve function and underlying moods.

Co-treatment with vactosertib, a novel, orally bioavailable activin receptor-like kinase 5 inhibitor, suppresses radiotherapy-induced epithelial-to-mesenchymal transition, cancer cell stemness, and lung metastasis of breast cancer.

BACKGROUND: Acquired metastasis and invasion of cancer cells during radiotherapy are in part due to induction of epithelial-to-mesenchymal transition (EMT) and cancer stem cell (CSC) properties, which are mediated by TGF-ß signaling. Here we evaluated the anti-metastatic therapeutic potential of vactosertib, an orally bioavailable TGF-ß type I receptor (activin receptor-like kinase 5, ALK5) inhibitor, via suppression of radiation-induced EMT and CSC properties, oxidative stress generation, and breast to lung metastasis in a breast cancer mouse model and breast cancer cell lines. MATERIALS AND METHODS: Co-treatment of vactosertib with radiation was investigated in the 4T1-Luc allografted BALB/c syngeneic mouse model and in 4T1-Luc and MDA-MB-231 cells. The anti-metastatic therapeutic potential of vactosertib in breast cancer was investigated using fluorescence immunohistochemistry, real-time quantitative reverse transcription-polymerase chain reaction, western blotting, wound healing assay, mammosphere formation assay, and lung metastasis analysis in vitro and in vivo. RESULTS: Radiation induced TGF-ß signaling, EMT markers (Vimentin, Fibronectin, Snail, Slug, Twist, and N-cadherin), CSC properties (expression of pluripotent stem cell regulators, mammosphere forming ability), reactive oxygen species markers (NOX4, 4-HNE), and motility of breast cancer cells in vitro and in vivo. Vactosertib attenuated the radiation-induced EMT and CSC properties by inhibiting ROS stress in breast cancer. Moreover, vactosertib combined with radiation showed a significant anti-metastatic effect with suppression of breast to lung metastasis in vivo. CONCLUSIONS: These results indicate that inhibition of TGF-ß signaling with vactosertib in breast cancer patients undergoing radiotherapy would be an attractive strategy for the prevention of cancer metastasis and recurrence.

Radiotherapy-induced oxidative stress and fibrosis in breast cancer are suppressed by vactosertib, a novel, orally bioavailable TGF-ß/ALK5 inhibitor.

Radio-resistance resulting from radiotherapy-induced fibrosis is a major clinical obstacle in breast cancer treatment because it typically leads to cancer recurrence, treatment failure, and patient death. Transforming growth factor-ß (TGF-ß) is a key signal messenger in fibrosis, which plays an important role in radiation-induced fibrosis and cancer stem cell (CSC) development, may be mediated through the generation of oxidative stress. This study was conducted to confirm the efficacy of vactosertib, a TGF-ß/ALK5 inhibitor, as a potent inhibitor in radiation-induced oxidative stress generation, fibrosis and CSC development. We used a 4T1-Luc allograft BALB/c syngeneic mouse model and 4T1-Luc and MDA-MB-231 cells for histological analysis, qRT-PCR, western blotting, ROS analysis, mammosphere formation analysis, monolayer fluorescence imaging analysis. Radiotherapy induces TGF-ß signaling, oxidative stress markers (4-HNE, NOX2, NOX4, PRDX1, NRF2, HO-1, NQO-1), fibrosis markers (PAI-1, α-SMA, FIBRONECTIN, COL1A1), and CSC properties. However, combination therapy with vactosertib not only inhibits these radiation-induced markers and properties by blocking TGF-ß signaling, but also enhances the anticancer effect of radiation by reducing the volume of breast cancer. Therefore, these data suggest that vactosertib can effectively reduce radiation fibrosis and resistance in breast cancer treatment by inhibiting radiation-induced TGF-ß signaling and oxidative stress, fibrosis, and CSC.

Effects of Personal Low-Frequency Stimulation Device on Myalgia: A Randomized Controlled Trial.

Electrotherapy is commonly used for myalgia alleviation. Low-frequency stimulation (LFS) is primarily used for controlling acute and chronic pain and is a non-invasive therapy that can be easily performed with electric stimulation applied on the skin. However, little evidence exists regarding the pain alleviation effects of personal low-frequency stimulation device for home use. Moreover, no studies have compared myalgia alleviation effects between personal low-frequency stimulation (PLS) and physical therapy (PT), which are most commonly used for patients with myalgia in hospitals and clinics. Therefore, we aimed to investigate the pain alleviation effects of PLS in patients with myalgia and compare these effects with those of conventional PT (transcutaneous electrical nerve stimulation + ultrasound). In total, 39 patients with myalgia in the neck, shoulder, back, and waist areas were randomly assigned to the personal low-frequency stimulation group (PLSG: n = 20) and physical therapy group (PTG: n = 19). Both groups were treated for 3 weeks (20 min per session and 5 sessions per week). Patients were assessed for pain intensity by surface electromyography (sEMG), visual analogue scale (VAS) and a short-form McGill pain questionnaire (SF-MPQ) before and after the intervention period. Our results showed that PLSG showed a tendency of muscle relaxation with a significant decrease in sEMG in the neck (p = 0.0425), shoulder (p = 0.0425), and back (p = 0.0046) areas compared to the control group. However, there was no significant difference in waist area. Additionally, VAS scores significantly decreased between pre- and post-treatment in both PTG (p = 0.0098), and PLSG (p = 0.0304) groups, but there was no significance difference between the groups. With respect to SF-MPQ, the PLSG showed greater pain alleviation (5.23 ± 0.25) effects than the PTG (6.23 ± 0.25). Accordingly, our results suggest that PLS treatment using a home device might offer positive assistance in pain alleviation for patients with myalgia that is as equally effective as conventional PT treatment. However, further detailed studies are required considering larger samples to fully claim the effectiveness of this device.

Mechanical Changes of the Lumbar Intervertebral Space and Lordotic Angle Caused by Posterior-to-Anterior Traction Using a Spinal Thermal Massage Device in Healthy People.

BACKGROUND: The axial (horizontal) traction approach has been traditionally used for treatment of low back pain-related spinal disorders such as nuclear protrusion, primary posterolateral root pain, and lower thoracic disc herniation; however, it is known to have some technical limitations due to reductions of the spinal curve. Lumbar lordosis plays a pivotal function in maintaining sagittal balance. Recently, vertical traction and combination traction have been attracting attention due to improving therapeutic outcomes, although evidence of their clinical application is rare; therefore, this study was conducted to investigate the mechanical changes of lumbar intervertebral space, lordotic angle, and the central spinal canal area through vertical traction treatment using a spinal massage device in healthy participants. METHODS: In total, 10 healthy subjects with no musculoskeletal disorders and no physical activity restrictions participated. The participants lay on the experimental device (CGM MB-1901) in supine extended posture and vertical traction force was applied in a posterior-to-anterior direction on the L3-4 and L4-5 lumbar sections at level 1 (baseline) and level 9 (traction mode). Magnetic resonance (MR) images were recorded directly under traction mode using the MRI scanner. The height values of the intervertebral space (anterior, center, and posterior parts) and lordosis angle of the L3-4 and L4-5 sections were measured using Image J software and the central spinal canal area (L4-5) was observed through superimposition method using the MR images. All measurement and image analyses were conducted by 2 experienced radiologists under a single-blinded method. RESULTS: The average height values of the intervertebral space under traction mode were significantly increased in both L3-4 and L4-5 sections compared to baseline, particularly in the anterior and central parts but not in the posterior part. Cobb's angle also showed significant increases in both L3-4 and L4-5 sections compared to baseline (p < 0.001). The central spinal canal area showed a slightly expanded feature in traction mode. CONCLUSIONS: In this pilot experiment, posterior-to-anterior vertical traction on L3-4 and L4-5 sections using a spinal massage device caused positive and significant changes based on increases of the intervertebral space height, lumbar lordosis angle, and central spinal canal area compared to the baseline condition. Our results are expected to be useful as underlying data for the clinical application of vertical traction.

A Review of the Medical Challenges of Using Direct Oral Anticoagulants in Real-World Practice.

Clinical guidelines for management of non-valvular atrial fibrillation or venous thromboembolism currently recommend direct oral anticoagulants as the preferred strategy for antithrombotic treatment. As a result, they are increasingly being used as an alternative to conventional therapy. However, they are unlikely to completely replace conventional approaches, due to a number of existing medical challenges. These challenges relate to the uncertainty of optimal dose regimens and the strategy of using them in specific patient populations with non-valvular atrial fibrillation or venous thromboembolism. The efficacy and safety profile of dabigatran among various regions may differ, depending on regional variations in dosing recommendations. Furthermore, optimal dose regimens may be different between Asian and non-Asian populations. It will be necessary to collect real-world clinical data on the use of edoxaban in patients with non-valvular atrial fibrillation with high-creatinine clearances, to determine the optimal dose required for stroke protection. In addition, the efficacy of combination therapy utilizing direct oral anticoagulants and antiplatelet agents has not yet been established in patients with non-valvular atrial fibrillation with acute coronary syndrome and/or percutaneous coronary intervention with stenting. Low-molecular-weight heparin is, therefore, suggested to be used in preference to vitamin K antagonists or direct oral anticoagulants in current clinical practice guidelines, as indirect comparisons suggests that oral anticoagulants are less effective than low-molecular-weight heparin. Consequently, we need to focus on the outcomes of ongoing studies and review more real-world data in heterogeneous populations to complement clinical data obtained from controlled studies with highly selective populations. Therefore, direct oral anticoagulants should be used with caution based on individual assessments of thromboembolic and bleeding risks as well as other clinical characteristics.

Use of a Spinal Thermal Massage Device for Anti-oxidative Function and Pain Alleviation.

Background: Elderly people are vulnerable to a variety of diseases, including chronic pain, which reduces their levels of physical fitness. Thermal massage has been shown to relieve pain and activate antioxidant enzymes. The objective of this study was to determine whether thermal massaging of the spinal column can reduce muscle pain and induce antioxidant function. Methods: This study included participants aged ≥60 years with lower back pain. The participants were assigned to either an experimental group who received spinal column thermal massage and standard rehabilitative treatment or a control group who received standard rehabilitative treatment only. Data from a total of 116 participants (61 and 55 in the control and experimental groups, respectively) were used for analysis. Participants were assessed before treatment and at 4 (POST1) and 8 weeks (POST2) post-treatment, using a pain numeric rating scale (PNRS) and the Roland and Morris Disability Questionnaire (RMDQ), and by measuring the serum levels of superoxide dismutase (SOD), serum glutathione-peroxidase (GPx), and serum catalase (CAT). Results: The extent of pain reduction, as measured by the PNRS, was greater in the experimental group. The RMDQ score in the control group decreased at POST1, but the decrease was not maintained at POST2, whereas the decrease in POST1 in the experimental group continued until POST2. SOD concentrations were significantly higher in the experimental group at POST1 and POST2, and GPx levels were significantly higher in the experimental group at POST2; however, there were no changes in CAT concentrations. Incidentally, there was a significant correlation between antioxidant activity and pain perception in the experimental group. Conclusions: The study findings suggest that spinal column thermal massage reduces pain more effectively, improves self-reported levels of disability, and increases the antioxidant enzyme levels. Thermal massage may, therefore, be useful in the prevention and treatment of diseases associated with oxidation.

Real-Time Light-Guided Vocal Fold Injection: Ex Vivo Feasibility Study in a Canine Model.

OBJECTIVE: The transcricothyroid (CT) membrane approach is a good option for office-based vocal fold injection (VFI). However, because the needle tip is invisible during injection using the CT approach, precise localization requires a high level of experience, and mastering this approach involves a steep learning curve. To overcome current limitations, we conceptualized a novel technique: real-time light-guided VFI (RL-VFI), which enables simultaneous VFI under direct visualization of the lighted needle tip. Herein, we aimed to verify the feasibility of RL-VFI in cadaveric canine model, simulating the setting of office-based VFI, as well as to explore its clinical usefulness. STUDY DESIGN: Animal study. METHODS: A customized prototype device was developed. It consisted of three parts: light source, controller, and injector. Light source comprised laser diodes of two wavelengths (635 nanometers [nm], red; 532 nm, green). Four types of injector were developed using 40-mm needles of 23- and 25-gauge and optic fibers of 50 and 100 µm. ex vivo canine larynx was prepared for the experiment. Flexible laryngoscopy system was used to examine canine vocal folds. RESULTS: Various routes from three insertion points (3 mm, 10 mm, and 17 mm from the midline) were validated using the device. Regardless of the injection routes, the location of the needle tip was accurately indicated by light. RL-VFI was feasible under light guidance without difficulties. Moreover, precise and simultaneous re-injection could be performed at the intended point using the device. CONCLUSION: We introduced RL-VFI using our customized prototype device in an ex vivo canine larynx, simulating the setting of office-based VFI. Clinical application of RL-VFI will improve safety and precision of CT approach, as well as expand its applications in laryngology. LEVEL OF EVIDENCE: NA. Laryngoscope, 129:935-942, 2019.

Some posterior branches of extralaryngeal recurrent laryngeal nerves have motor fibers.

OBJECTIVES/HYPOTHESIS: Anatomical variations of the recurrent laryngeal nerve (RLN), such as extralaryngeal branching, are a well-known risk factor for RLN injury during thyroid surgery. This study aimed to analyze the surgical anatomy and to investigate the existence of posterior branch motor fibers of extralaryngeal RLNs. STUDY DESIGN: Prospective consecutive observational study. METHODS: This was a prospective cohort study of 366 patients between January 2014 and February 2016. Operative data included the type of operation, incidence of nerve bifurcation, the distances among anatomical landmarks. The motor fibers were evaluated using neurostimulation with laryngeal palpation. RESULTS: A total of 667 RLNs at risk were analyzed in this study, and of these 103 (14.5%) nerves were bifurcated or trifurcated before the laryngeal entry point (LEP). More extralaryngeal branched RLNs were observed on the right side than on the left (17.5% vs. 13.3%, P = .294). The mean distance of the LEP point of division was longer on the left side (16.2 ± 6.7 mm) than on the right (14.7 ± 5.9 mm, P = .132). All branched RLNs had a palpable laryngeal twitch when stimulating anterior branches. When stimulating posterior branches, 28.2%(29/103) of branched RLNs showed palpable laryngeal twitch. Overall incidence of posterior motor branch in total RLNs was 4.3% (29/667). CONCLUSIONS: The motor fibers of the RLN are all located in the anterior branch, whereas some posterior branches have motor function. Identification of all of the branches of the RLN may be mandatory to decrease the risk of postoperative nerve injury. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2678-2685, 2017.

Septochoanal Polyp with Metaplastic Ossification Mimicking Sinonasal Tumor: A Case Report.

Choanal polyps are a form of nasal polyps that grow toward the choana with a single stalk. Septochoanal polyp is a rare entity that originates from the mucosa of the nasal septum with choanal extension. The most common site of its origin is mainly the superior aspect of the posterior portion of the nasal septum. However, metaplastic ossification is a rare event in nasal polyp and to the best of our knowledge, septochoanal polyp with metaplastic ossification has not been reported in the literature. Herein, we report a case of huge septochoanal polyp with metaplastic ossification obstructing both the nasal cavity and nasopharynx, which was successfully removed via transnasal endoscopic approach.

Potential therapeutic mechanism of extremely low-frequency high-voltage electric fields in cells.

The aim of this survey was to provide background theory based on previous research to elucidate the potential pathway by which medical devices using extremely low-frequency high-voltage electric fields (ELF-HVEF) exert therapeutic effects on the human body, and to increase understanding of the AC high-voltage electrotherapeutic apparatus for consumers and suppliers of the relevant devices. Our review revealed that an ELF field as weak as 1-10 µ V/m can induce diverse alterations of membrane proteins such as transporters and channel proteins, including changes in Ca + + binding to a specific site of the cell surface, changes in ion (e.g., Ca + + ) influx or efflux, and alterations in the ligand-receptor interaction. These alterations then induce cytoplasmic responses within cells (Ca + + , cAMP, kinases, etc.) that can have impacts on cell growth, differentiation, and other functional properties by promoting the synthesis of macromolecules. Moreover, increased cytoplasmic Ca + + involves calmodulin-dependent signaling and consequent Ca + + /calmodulin-dependent stimulation of nitric oxide synthesis. This event in turn induces the nitric oxide-cGMP-protein kinase G pathway, which may be an essential factor in the observed physiological and therapeutic responses.

Supramaximal neurostimulation with laryngeal palpation to predict postoperative vocal fold mobility.

OBJECTIVES/HYPOTHESIS: Recurrent laryngeal nerve (RLN) injury during thyroidectomy or parathyroidectomy is a challenging issue and causes significant morbidity. We adopted the supramaximal stimulation protocol for neurostimulation with laryngeal palpation (NSLP) and tried to evaluate the predictive values of supramaximal NSLP for immediate postoperative vocal fold (VF) mobility. STUDY DESIGN: Prospective cohort study. METHODS: Prospectively, 293 patients who underwent thyroid and parathyroid surgery and 542 RLNs at risk were enrolled in this study. During NSLP, the current was escalated to 3 mA until definite laryngeal twitch was observed. Immediate postoperative VF mobility was evaluated using flexible laryngoscopy. RESULTS: Diagnostic accuracy of NSLP is calculated according to cutoff values of minimal current intensity (1 mA, 1.5 mA, and 2 mA). At 2mA, sensitivity was 81.82%, specificity 100%, positive predictive value 100%, and negative predictive value 99.62%. CONCLUSIONS: Supramaximal NSLP might be a simple and reliable method to predict immediate postoperative VF mobility in open thyroid and parathyroid surgeries when intraoperative neuromonitoring is unavailable. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2863-2868, 2016.

Office-based biopsies for laryngeal lesions: Analysis of consecutive 581 cases.

OBJECTIVES/HYPOTHESIS: Office-based biopsy (OBB) is widely used to diagnose suspicious laryngeal lesions. However, its routine use is still controversial and the algorithm for clinical strategy is not concrete. We tried to evaluate the accuracy of OBB as a diagnostic tool for laryngeal malignancy. METHODS: Medical data of 581 patients undergoing OBB were reviewed. Diagnostic values of OBB were analyzed for malignancy and malignancy/premalignancy. False negative rates (FNRs) were analyzed according to subsites, lesion sizes, and morphology. RESULTS: The collection rate of adequate specimens was 99.1%, and there were no complications during OBB. The false omission rates for malignancy of benign lesion; mild, moderate, and severe dysplasia; and carcinoma in situ (CIS) were 5.1%, 11.9%, 14.3%, 50.0%, and 100.0%, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for malignancy in OBB were 78.2%, 100.0%, 100.0%, and 87.3%, respectively. Those for malignancy/premalignancy in OBB were 88.2%, 86.7%, 85.7%, and 89.1%, respectively. The high FNRs were reported in glottis lesions (27.0%) and small lesions below 1 cm (27.5%). Morphologically fungating lesions showed low FNR (9.1%) compared to nonfungating ones. CONCLUSION: Office-based biopsy could be used as an initial diagnostic tool for laryngeal malignancy for early detection and avoidance of general anesthesia. However, operative re-biopsy should be considered when severe dysplasia or CIS were reported in OBB, or when the lesions are clinically suspicious for malignancy. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2513-2519, 2016.

Is 1/f sound more effective than simple resting in reducing stress response?

BACKGROUND: It has been previously demonstrated that listening to 1/f sound effectively reduces stress. However, these findings have been inconsistent and further study on the relationship between 1/f sound and the stress response is consequently necessary. OBJECTIVE: The present study examined whether sound with 1/f properties (1/f sound) affects stress-induced electroencephalogram (EEG) changes. METHODS: Twenty-six subjects who voluntarily participated in the study were randomly assigned to the experimental or control group. Data from four participants were excluded because of EEG artifacts. A mental arithmetic task was used as a stressor. Participants in the experiment group listened to 1/f sound for 5 minutes and 33 seconds, while participants in the control group sat quietly for the same duration. EEG recordings were obtained at various points throughout the experiment. After the experiment, participants completed a questionnaire on the affective impact of the 1/f sound. RESULTS: The results indicated that the mental arithmetic task effectively induced a stress response measurable by EEG. Relative theta power at all electrode sites was significantly lower than baseline in both the control and experimental group. Relative alpha power was significantly lower, and relative beta power was significantly higher in the T3 and T4 areas. Secondly, 1/f sound and simple resting affected task-associated EEG changes in a similar manner. Finally, participants reported in the questionnaire that they experienced a positive feeling in response to the 1/f sound. CONCLUSIONS: Our results suggest that a commercialized 1/f sound product is not more effective than simple resting in alleviating the physiological stress response.