Sensitization to house dust mite allergens might be related to the low sensitivity of ImmunoCAP to pollen allergen.

BACKGROUND: Skin prick test (SPT) and ImmunoCAP are widely used to diagnose allergies. However, previous studies showed discordance between the results of SPT and ImmunoCAP and there remains a lack of research to better understand the differences in results between the two tests. OBJECTIVE: We investigated factors that affected the discordance between SPT and ImmunoCAP results. METHODS: We reviewed the medical records of 94 subjects who underwent both SPT and ImmunoCAP for six allergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, alder, ragweed, mugwort, and Humulus japonicus). We retrospectively analyzed whether age, sex, body mass index, and allergic sensitization to house dust mite (HDM) or seasonal allergens affected the discordance of results between SPT and ImmunoCAP. RESULTS: The positivity rates for HDM allergens were similar between the two tests. For seasonal allergens, however, the positivity rates were much higher in the SPT than those in the ImmunoCAP. The concordance rates of the two tests were relatively higher for HDM than seasonal allergens. Moreover, the ratio of the subjects positive by SPT and negative by ImmunoCAP was higher for seasonal allergens. Positivity for HDM allergens by SPT resulted in a higher rate of mismatch between the two tests for seasonal allergens. CONCLUSIONS: The ImmunoCAP test for seasonal antigens showed low positivity rates compared to SPT in cases positive for HDM allergens. This suggests that the results of ImmunoCAP are less sensitive for seasonal allergens compared to the SPT in cases positive for HDM allergens.

Computed Tomography Findings in Patients with Samter's Triad: An Observational Study.

Samter's Triad is a disorder characterized by chronic rhinosinusitis (CRS) with nasal polyps (NPs), asthma, and intolerance to cyclooxygenase-1 inhibitors. However, there have been no studies investigating the prediction of Samter's Triad using imaging findings. Therefore, the authors aimed to investigate whether there is a difference in computed tomography (CT) findings between patients who have CRS with NPs and those with Samter's Triad. Patients were classified into a CRS group and a Samter group. Opacification was measured using data from CT scans by scoring each sinus on a numerical rating scale ranging from 0 to 4. The opacification scores of the ethmoid and frontal sinuses were significantly higher in the Samter's Triad group. Furthermore, Samter's Triad was more common in patients who scored ≤ 2 for maxillary opacification (7/16) than in those who scored ≥3 (4/45, p=0.005). Patients with Samter's Triad exhibited a tendency toward higher opacification scores for the ethmoid and frontal sinuses, with a relatively lower opacification score for the maxillary sinus. These findings could be helpful in distinguishing patients with Samter's Triad from those who have CRS with NPs, and to plan treatment strategies without having to perform additional laboratory or radiological tests.

The Application of Fibrin/Hyaluronic Acid-Poly(l-Lactic-co-Glycolic Acid) Construct in Augmentation Rhinoplasty.

Although many graft materials have been used for augmentation rhinoplasty, an ideal graft has not yet been developed. As the field of tissue engineering has been developing, it has been applied to the reconstruction of many organs, but its application in the rhinoplasty field is still limited. This study evaluated the utility of allogenic chondrocytes with fibrin/hyaluronic acid (HA)-poly(l-lactic-co-glycolic acid) (PLGA) constructs in augmentation rhinoplasty. Chondrocytes from rabbit auricular cartilage were isolated and cultured with fibrin/HA hydrogels and implanted into PLGA scaffolds. After 8 weeks of in vitro culture, the scaffolds were implanted in the nasal dorsum of six rabbits. Eight weeks postoperatively, the implanted sites were evaluated with gross, radiologic, and histologic analysis. In vitro, more than 90% of the seeded chondrocytes in the PLGA scaffolds survived for 2 weeks, and they produced a large amount of extracellular matrix and were well differentiated. The grafts maintained their initial shape for 8 weeks after implantation. Radiological and histological evaluations showed that the structure was well maintained with minimal inflammatory response and appropriate elevation levels. However, the formation of neo-chondrocytes was not observed. PLGA scaffolds seeded with fibrin/HA and allogenic chondrocytes can be a biocompatible augmentation material in rhinoplasty in the future.

Hypoxia Modulates Epithelial Permeability via Regulation of Vascular Endothelial Growth Factor in Airway Epithelia.

Hypoxia resulting from occlusion of the sinus ostium is known to be one of the major pathogenic mechanisms of sinusitis. Hypoxia-inducible factor (HIF)-1 is a widely known transcription factor that induces the cellular response to hypoxic conditions and activates the transcription of several genes, including vascular endothelial growth factor (VEGF). We hypothesized that induced permeability caused by hypoxia is a major pathophysiologic mechanism of upper airway diseases, such as sinusitis. The aim of this study was to investigate the mechanism of hypoxia-induced hyperpermeability, which mediates increased paracellular permeability and enhanced microbial invasiveness in the airway epithelium. We show that expression of VEGF mRNA and protein and HIF-1α protein increased as a function of time under hypoxia in normal human nasal epithelial cells. Our results also indicate that VEGF expression was induced by transfection with a mammalian expression vector encoding HIF-1 but down-regulated by transfection with small interfering RNA specific for HIF-1α under hypoxic conditions. Results of a transepithelial permeability assay measuring transepithelial electrical resistance indicated that permeability was increased as a function of time under hypoxia and was rescued by anti-VEGF monoclonal antibody (bevacizumab) and small interfering RNA specific for HIF-1α. We detected up-regulated HIF-1α and VEGF expression in mucosal epithelium samples from patients with sinusitis compared with normal mucosal epithelium using Western blotting and immunohistochemical staining. In conclusion, we suggest that the hypoxia-HIF-1α-VEGF axis plays an important role in hyperpermeability of airway epithelial cells, implying a role in the pathophysiology of upper respiratory tract diseases, such as sinusitis.

Correlation between symptoms and objective findings may improve the symptom-based diagnosis of chronic rhinosinusitis for primary care and epidemiological studies.

BACKGROUND: In primary care and epidemiological studies of chronic rhinosinusitis (CRS), symptom-based diagnosis is common, yet limited, because endoscopic and radiological signs are not considered. OBJECTIVES: To evaluate the correlation between symptoms and objective findings of CRS to improve its symptom-based diagnosis for primary care and epidemiological studies by using data from a large-scale nationwide epidemiological study, the Korean National Health and Nutrition Examination Survey (KNHANES). DESIGN: Cross-sectional study. SETTING: Data from 2008 to 2012 KNHANES. PARTICIPANTS: 29,225 Adults aged >19 years. OUTCOME MEASURES: Questionnaires targeted two major (nasal blockage and anterior/posterior nasal drip) and two minor (facial pain/pressure and reduction or loss of smell) symptoms. Nasal polyps or mucopurulent discharge from the middle meatus was defined as positive endoscopic findings for diagnosing CRS. RESULTS: Of the four symptoms, reduction or loss of smell was the symptom most significantly related to positive endoscopic findings in multivariable analysis (OR=1.936 (95% CI 1.604 to 2.337)). The combinations of symptoms showed higher ORs than individual symptoms and combinations of reduction or loss of smell with other symptoms were statistically more reliable for positive endoscopic findings than other combinations. CONCLUSIONS: Our results show that reduction or loss of smell was the symptom most significantly related to positive nasal endoscopic findings. Therefore, symptom-based diagnosis of CRS can be improved by considering reduction or loss of smell as an important symptom for positive endoscopic findings of CRS.

Five-Year Subjective Outcomes of Obstructive Sleep Apnea Surgery: A Multiinstitutional Study.

OBJECTIVES: To evaluate the effect of obstructive sleep apnea (OSA) surgery on long-term (5-year) subjective outcomes, including sleep disordered breathing (SDB) symptoms and other complications, in patients with OSA. METHODS: We enrolled patients who underwent diagnostic polysomnography for OSA between January 2006 and December 2006 in ten hospitals. Patients either were treated for OSA or were not treated for OSA. All patients completed a brief telephone survey regarding their SDB signs and symptoms (e.g., snoring, apnea, nocturnal arousals, and daytime sleepiness), positive airway pressure (PAP) compliance, and any adverse effects of either the surgery or PAP. A positive subjective outcome for either surgery or no treatment was taken to be the alleviation of apnea, defined as a ≥50% increase in score. A positive subjective outcome (compliance) for PAP was defined as a PAP usage of ≥4 hours per night and ≥5 days per week. RESULTS: A total of 229 patients were included in this study. Patients were divided into three groups: a surgery group (n=87), a PAP group (n=68), and a control (untreated) group (n=74). The surgery group exhibited significant improvement in all SDB symptoms compared with the control group. The long-term subjective outcomes of the surgery (52.9%) and PAP (54.4%) groups were significantly better than those of the control group (25.0%). The subjective outcome of the surgery group was not significantly different from that of the PAP group. The overall surgical complication rate was 23.0% (20 of 87) in the surgery group, and 55.0% (22 of 40) of all patients with PAP experienced adverse effects. CONCLUSION: The extent of SDB symptoms was consistently improved in patients with OSA at 5 years postsurgery. Information about the potential long-term subjective outcomes should be provided to patients when considering surgery.

Association of body mass index and other factors with histamine skin reactivity in adults with allergic nasal symptoms.

BACKGROUND: The skin-prick test is the most commonly used method to diagnose allergy. In addition, histamine skin reactivity is used as a positive control for the skin-prick test. However, there is individual variation in histamine skin reactivity. The factors that influence individual variation in histamine skin reactivity remain unknown. OBJECTIVES: We aimed to investigate the factors associated with histamine skin reaction. METHODS: Ninety-seven subjects who underwent a skin-prick test to diagnose allergic rhinitis were enrolled in this study. The skin-prick test was performed with six common allergens. The wheal size of the histamine skin reaction was analyzed; other variables included age, sex, body mass index (BMI), atopy, smoking history, and the testing season. RESULTS: The wheal size in the histamine skin test was significantly associated with age and BMI. The association between histamine skin reactivity and BMI was also present in multivariate analysis, adjusted for age, sex, atopy, smoking history, and season. CONCLUSION: Histamine skin reactivity increased with BMI (degree of obesity). This association should be considered for better interpretation of the skin-prick test. Further studies regarding the mechanism for this association are needed.

Efficiency and durability of hyaluronic acid of different particle sizes as an injectable material for VF augmentation.

CONCLUSION: The results of the present investigation suggest that modification of HA could improve efficiency and durability in augmentation laryngoplasty. OBJECTIVES: Injection laryngoplasty (IL) is one of the most suitable options for treatment of glottic insufficiency, which is caused by vocal fold (VF) paralysis, atrophy, or scarring. Hyaluronic acid (HA) is a widely used material for VF injection. This study was intended to evaluate the durability and efficiency of HA of different particle sizes for VF augmentation. METHODS: Three types of HA, Restylane®, monophasic low-viscosity, and unequal particle-sized middle-viscosity HA were injected into the left VF of three groups with eight rabbits each. RESULTS: After 6 and 10 weeks, the injected site was evaluated endoscopically, histologically, radiologically, and functionally. None of the 24 rabbits showed any signs of respiratory distress. Computed tomography (CT) images and endoscopic evaluation revealed sufficient augmented volume of the injected VF in all treated groups 6 weeks after the injection. Histological data at week 10 showed that unequal particle-sized HA did not migrate from its original injection site, while other HAs migrated to the periphery of the arytenoid cartilage. Videokymographic analysis showed more favorable vibrations of unequal particle-sized HA injected VF mucosa 10 weeks post-injection, compared to the other treatment groups.

Clinical Implication of Heart Rate Variability in Obstructive Sleep Apnea Syndrome Patients.

UNLABELLED: Obstructive sleep apnea syndrome (OSAS) is a common disease with the prevalence of approximately 10% in general population, and this disease entity is considered to be highly related with the development of cerebrovascular and cardiovascular diseases. In the pathogenesis of cardiovascular disease, maintaining the homeostasis of autonomic nervous system (ANS) is critical. To evaluate the homeostasis of ANS, heart rate variability (HRV) is commonly used. The object of this study was to evaluate the homeostasis of ANS using the parameters of HRV and to elucidate the correlation between the parameters and apnea-hypopnea index (AHI). METHODS: Retrospective review of 806 patients was performed and 164 patients who were diagnosed as having OSAS by in-room polysomnography and met the criteria of age, sex, and body mass index were enrolled. The calculation of HRV parameters was executed using echocardiographic data from polysomnography. RESULTS: Between the control group (N = 81, AHI < 5) and OSAS patient group (N = 83, AHI > 15), standard deviation of NN (SDNN) intervals, SDNN index, HRV triangular index, very low frequency (VLF), low frequency (LF), 5-minute total power (TP), and low-frequency to high-frequency (LF/HF) ratio showed significant differences. In the correlation analysis between AHI and HRV parameters, only LF/HF ratio was proven to be significant. CONCLUSIONS: Elucidating the imbalance of ANS in OSAS patients was feasible by HRV and its parameters.

Cultured chondrocyte and porcine cartilage-derived substance (PCS) construct as a possible dorsal augmentation material in rhinoplasty: A preliminary animal study.

As there is no single ideal material for dorsal augmentation in rhinoplasty, there has been a continuing need for the development of improved materials. Therefore, we aimed to evaluate the outcome of using a novel tissue-engineered construct composed of autologous chondrocytes cultured with a porcine cartilage-derived substance (PCS) scaffold as an augmentation material in rhinoplasty. A scaffold derived from decellularized and powdered porcine articular cartilage was prepared. The rabbit articular cartilage was used as the source of homologous chondrocytes, which were expanded and cultured with the PCS scaffold for 7 weeks. The chondrocyte-PCS constructs were then surgically implanted on the nasal dorsum of six rabbits. Four and eight weeks after implantation, the gross morphology, radiologic images, and histologic features of the site of implant were analyzed. The rabbits showed no signs of postoperative inflammation and infection. The degree of dorsal augmentation was maintained during the 8-week postoperative observation period. Postoperative histologic examinations showed chondrocyte proliferation without an inflammatory response. However, neo-cartilage formation from the constructs was not confirmed. The biocompatibility and structural features of tissue-engineered chondrocyte-PCS constructs indicate their potential as candidate dorsal augmentation material for use in rhinoplasty.

Surgical outcomes of primary and revision augmentation rhinoplasty using a processed fascia lata.

BACKGROUND: Dorsal augmentation is the most commonly performed procedure in rhinoplasty for Asian patients. Due to the anatomic features of the Asian nose, the use of nonautologous materials to obtain a proper degree of augmentation is inevitable in most cases. Because the use of nonautologous materials possesses a higher risk of complications, surgeons are concerned about selecting suitable materials for the procedure, especially in revision rhinoplasty. Therefore, this study was designed to evaluate the suitability and usefulness of a homologous material, Tutoplast-processed fascia lata (TPFL), in revision augmentation rhinoplasty. METHODS: Retrospective analysis of 104 rhinoplasty patients (primary, 86; revision, 18) who had undergone dorsal augmentation using TPFL was conducted. The comparison of surgical outcomes between primary and revision surgery was made using objective [dorsal height (DH) and radix height (RH), complication rate] and subjective (patient satisfaction) parameters. RESULTS: The degree of augmentation represented by DH and RH was comparable between primary and revision rhinoplasty using TPFL. In comparing the rate of postoperative complications, only minor incidents were noted, in six cases after primary surgery and in one case after revision surgery. Patient satisfaction was measured in both primary and revision augmentation, with a significant difference observed between the two groups (40.57 ± 9.25 versus 31.48 ± 7.59; p < 0.05). CONCLUSION: TPFL is a feasible implant material that delivers suitable augmentation and patient satisfaction with minimal morbidity in both primary and revision rhinoplasty.

The Application of Three-Dimensional Printing in Animal Model of Augmentation Rhinoplasty.

The role of three-dimensional (3D) printing has expanded in diverse areas in medicine. As plastic surgery needs to fulfill the different demands from diverse individuals, the applications of tailored 3D printing will become indispensable. In this study, we evaluated the feasibility of using 3D-printed polycaprolactone (PCL) scaffold seeded with fibrin/chondrocytes as a new dorsal augmentation material for rhinoplasty. The construct was surgically implanted on the nasal dorsum in the subperiosteal plane of six rabbits. The implants were harvested 4 and 12 weeks after implantation and evaluated by gross morphological assessment, radiographic imaging, and histologic examination. The initial shape of the implant was unchanged in all cases, and no definite post-operative complications were seen over the 3-month period. Radiologic evaluation confirmed that implants remained in the initial location without migration or extrusion. Histologic evaluations showed that the scaffold architectures were maintained with minimal inflammatory reactions; however, expected neo-chondrogenesis was not definite in the constructs. A new PCL scaffold designed by 3D printing method seeded with fibrin/chondrocytes can be a biocompatible augmentation material in rhinoplasty in the future.

Tissue-engineered tracheal reconstruction using mesenchymal stem cells seeded on a porcine cartilage powder scaffold.

Tissue engineering using a biocompatible scaffold with various cells might be a solution for tracheal reconstruction. We investigated the plausibility of using mesenchymal stem cells (MSCs) seeded on a porcine cartilage powder (PCP) scaffold for tracheal defect repair. PCP made with minced and decellularized porcine articular cartilage was molded into a 5 × 12 mm (height × diameter) scaffold. MSCs from young rabbit bone marrow were expanded and cultured with the PCP scaffold. After 7 weeks culture, the tracheal implants were transplanted on a 5 × 10 mm tracheal defect in six rabbits. 6 and 10 weeks postoperatively, the implanted area was evaluated. None of the six rabbits showed any sign of respiratory distress. Endoscopic examination revealed that respiratory epithelium completely covered the regenerated trachea and there were no signs of collapse or blockage. A patent luminal contour of the trachea was observed on the computed tomography scan in all six rabbits and the reconstructed areas were not narrow compared to normal adjacent trachea. Histologic examination showed that neo-cartilage was successfully produced with minimal inflammation or granulation tissue. Ciliary beating frequency of the regenerated epithelium was not significantly different from the normal adjacent mucosa. MSCs cultured with a PCP scaffold successfully restored not only the shape but also the function of the trachea without any graft rejection.

Immediate re-insertion of non-autologous materials in revision augmentation rhinoplasty.

OBJECTIVE: This paper aims to study whether immediate re-insertion of non-autologous augmentation material in revision augmentation rhinoplasty is a safe surgical strategy creating a successful and functional aesthetic outcome. STUDY DESIGN: Retrospective review and analysis of medical records. SETTING: Tertiary referral hospital. SUBJECTS AND METHODS: A retrospective analysis of 11 consecutive patients who had undergone removal of previous augmentation material and immediate re-insertion of non-autologous material in revision augmentation rhinoplasty was performed. Demographics, surgical approaches, augmentation materials, material-related complications, time interval between surgeries, surgical outcome, and follow-up period were included in the analysis to evaluate our surgical strategy. RESULTS: A successful surgical outcome with respect to both functional and aesthetic aspects was obtained in nine of the 11 enrolled patients. In 1 patient, there was a recurrence of material-related complication, while another patient experienced unsatisfactory graft displacement. The unsuccessful cases had 2 common features in that silicone and endonasal approaches were used in the primary and revision surgeries, respectively. CONCLUSION: Removal of previous augmentation material and immediate re-insertion of non-autologous material for dorsal augmentation in revision rhinoplasty is feasible with respect to functional and aesthetic aspects of patient outcome.

Can mitochondrial dysfunction be a predictive factor for oxidative stress in patients with obstructive sleep apnea?

Mitochondrial dysfunction reflects a lifelong cumulative burden of cellular damage, and a decrease in mitochondrial DNA (mtDNA) copy number is associated with oxidative stress and chronic inflammation. The goal of this study was to assess whether mitochondrial dysfunction and a decrease in mtDNA copy number are common features of patients with obstructive sleep apnea syndrome (OSA). We compared mtDNA copy number between 20 healthy volunteers and 20 patients with OSA and investigated whether a significant attenuation of mtDNA copy number was observed in genomic DNA isolated from whole blood of OSA patients. Our observations lead to the hypothesis that mtDNA copy number is lower in whole blood DNA of OSA subjects and might be related to OSA severity, reflecting excessive oxidative stress in patients with OSA.

Tissue-engineered tracheal reconstruction using three-dimensionally printed artificial tracheal graft: preliminary report.

Three-dimensional printing has come into the spotlight in the realm of tissue engineering. We intended to evaluate the plausibility of 3D-printed (3DP) scaffold coated with mesenchymal stem cells (MSCs) seeded in fibrin for the repair of partial tracheal defects. MSCs from rabbit bone marrow were expanded and cultured. A half-pipe-shaped 3DP polycaprolactone scaffold was coated with the MSCs seeded in fibrin. The half-pipe tracheal graft was implanted on a 10 × 10-mm artificial tracheal defect in four rabbits. Four and eight weeks after the operation, the reconstructed sites were evaluated bronchoscopically, radiologically, histologically, and functionally. None of the four rabbits showed any sign of respiratory distress. Endoscopic examination and computed tomography showed successful reconstruction of trachea without any collapse or blockage. The replaced tracheas were completely covered with regenerated respiratory mucosa. Histologic analysis showed that the implanted 3DP tracheal grafts were successfully integrated with the adjacent trachea without disruption or granulation tissue formation. Neo-cartilage formation inside the implanted graft was sufficient to maintain the patency of the reconstructed trachea. Scanning electron microscope examination confirmed the regeneration of the cilia, and beating frequency of regenerated cilia was not different from those of the normal adjacent mucosa. The shape and function of reconstructed trachea using 3DP scaffold coated with MSCs seeded in fibrin were restored successfully without any graft rejection.

Tracheal reconstruction using chondrocytes seeded on a poly(L-lactic-co-glycolic acid)-fibrin/hyaluronan.

Reconstruction of trachea is still a clinical dilemma. Tissue engineering is a recent and promising concept to resolve this problem. This study evaluated the feasibility of allogeneic chondrocytes cultured with fibrin/hyaluronic acid (HA) hydrogel and degradable porous poly(L-lactic-co-glycolic acid) (PLGA) scaffold for partial tracheal reconstruction. Chondrocytes from rabbit articular cartilage were expanded and cultured with fibrin/HA hydrogel and injected into a 5 × 10 mm-sized, curved patch-shape PLGA scaffold. After 4 weeks in vitro culture, the scaffold was implanted on a tracheal defect in eight rabbits. Six and 10 weeks postoperatively, the implanted sites were evaluated by bronchoscope and radiologic and histologic analyses. Ciliary beat frequency (CBF) of regenerated epithelium was also evaluated. None of the eight rabbits showed any sign of respiratory distress. Bronchoscopic examination did not reveal stenosis of the reconstructed trachea and the defects were completely recovered with respiratory epithelium. Computed tomography scan showed good luminal contour of trachea. Histologic data showed that the implanted chondrocytes successfully formed neocartilage with minimal granulation tissue. CBF of regenerated epithelium was similar to that of normal epithelium. Partial tracheal defect was successfully reconstructed anatomically and functionally using allogeneic chondrocytes cultured with PLGA-fibrin/HA composite scaffold.

Treatment outcomes of sinonasal adenoid cystic carcinoma: 30 cases from a single institution.

OBJECTIVE: To establish the clinical features and prognostic factors of sinonasal adenoid cystic carcinoma (ACC). MATERIAL AND METHODS: Thirty patients with histopathological diagnosis of sinonasal ACC who were treated at Severance Hospital between 1990 and 2010 were included in this retrospective chart review study. RESULTS: The 5-year disease-specific survival and disease-free survival rates were 75.3% and 37.2%, respectively. The maxillary sinus (63.3%) and nasal cavity (23.3%) were the most common sites of primary tumour. Most patients were diagnosed with advanced-stage (III/IV) disease (80.0%) and had undergone surgery and postoperative radiotherapy (70.0%). The most common histopathological subtype was cribriform type (40.9%). Local recurrence rate and distant metastasis rates were 26.7% and 23.3%, respectively. The mean time from primary treatment to recurrence was 44.5 months. Sinonasal ACC patients with stage IV and T4 disease had significantly worse survival than those with low stage and T disease. Patients with local recurrence had worse disease-specific survival than those with distant recurrence. Distant metastasis was associated with disease-free survival but not disease-specific survival. CONCLUSION: Despite the frequent occurrence of distant metastasis, early diagnosis and effective local control seemed to be the most important factors influencing the survival of sinonasal ACC.

Chemopreventive role of green tea in head and neck cancers.

In the era of personalized medicine, selecting the ideal treatment modality for head and neck cancer is becoming more complex. Also, despite the use of the newest agents, overall survival has not been improved notably over the past few decades. Currently, in accordance with the development of diagnostic tools, prevention and early detection of cancer are being emphasized more in obtaining better treatment outcomes. Among the various cancer preventative methods, the use of green tea is one of the most common approaches, and tea is known to be involved in multiple steps of carcinogenesis. Thus, in this short review, the protective roles of green tea components against the initiation, progression, and metastasis of head and neck malignancies will be discussed.

Protease-activated receptor 2-dependent fluid secretion from airway submucosal glands by house dust mite extract.

BACKGROUND: The submucosal gland (SMG) is important in the control of airway surface fluid. Protease-activated receptor (PAR) 2 contributes to the pathophysiology of allergies in response to nonspecific allergens bearing proteases and anion secretion. House dust mites (HDMs) have abundant proteases that can activate PAR2, but little is known about the direct effect of HDM on SMG secretion. OBJECTIVE: The aim of this study was to investigate the effect of HDMs on glandular secretion and its mechanism in allergic patients, patients with chronic rhinosinusitis (CRS), or both. METHODS: Inferior nasal turbinates were harvested from 55 patients and classified into 4 groups (the control, allergic rhinitis [AR], CRS, and AR+CRS groups). A microscope attached to a digital camera was used to quantify mucus bubbles from individual SMGs while stimulated with HDM extract, PAR2-activating peptide, and carbachol. PAR2 expression in the SMG was determined by means of immunostaining with anti-PAR2 mAb. RESULTS: HDM induced a significantly higher secretion rate and number of responding glands in the AR and AR+CRS groups than in the control group. Interestingly, patients in the CRS group, who had no HDM-specific IgE antibody, showed a higher response than the control group, and its response was suppressed by a PAR2-selective antagonist. The responses to PAR2-activating peptide were similar to those to HDM, and their secretion rates positively correlated with HDM responses. PAR2 was highly expressed in all 3 disease groups with immunostaining. CONCLUSIONS: HDM allergens can induce glandular secretion in patients with AR, CRS, or both, and PAR2 represents a possible mechanism for nonspecific hyperreactivity in inflammatory airway diseases.