Bibliometric analysis of auriculotherapy research trends over the past 20 years.

OBJECTIVES: Auriculotherapy has long been used to treat various diseases. We analyzed and visualized auriculotherapy's geographical distribution, key contributors, and thematic trends over the past 20 years to provide current trends in auriculotherapy field and to offer recommendations for future research directions. DESIGN/SETTING: We searched for relevant studies in the Web of Science between January 10, 2003, and December 31, 2022. A bibliometric analysis was performed using VOSviewer for annual publications, journals, countries, institutions, authors, and keywords. RESULTS: A total of 800 studies were included in the analysis, and the number of studies steadily increased over the 20 examined years. In 2018, there was a noteworthy rise in publications, nearly twice as many as the preceding year. Integrative & complementary medicine was the most researched area, with most articles published in Evidence-Based Complementary and Alternative Medicine. China was the country with the most published research, and the most active organization was Guangzhou University of Chinese Medicine in China, followed by Kyung Hee University in South Korea. The most prolific author was Yeh Mei-ling, who reported the effects of auriculotherapy on dysmenorrhea and smoking cessation. Keyword analysis revealed four clusters: pain, mental health, obesity, and smoking cessation. CONCLUSION: Auriculotherapy research primarily focused on clinical studies related to pain, obesity, smoking cessation, and depression. Future research should place greater emphasis on verifying the mechanisms of auriculotherapy for specific ailments and may require efforts to enhance the robustness of clinical trials. Through visual analysis, our study may serve as a foundational resource, offering valuable insights into the trajectory of auriculotherapy research.

Survey on the current usage of ultrasound-guided procedures in Korean Medicine Clinics and Hospitals.

Ultrasound-guidance is applied during the administration of Korean medicine (KM) interventions to improve the safety and effectiveness of the interventions. Although many case series and reports on the use of ultrasound-guided KM interventions have been reported, no study has investigated the current use of ultrasound-guidance in clinical practice by doctors of Korean medicine (KMDs). An online survey was conducted with questions examining the status of ultrasound-guidance usage among KMDs practicing in various KM clinical settings. Survey responses from 335 KMDs were collected. Ultrasound started to be widely used in the clinical practice of KM since 2022. The primary objective of using ultrasound-guidance was "To improve the accuracy and efficacy" by 54.6%. Ultrasound-guidance was most frequently applied for shoulder joint diseases, and pharmacopuncture was the most frequently used intervention (76.1% and 90.4%, respectively). The respondents reported that effectiveness could be enhanced the most in nerve entrapment syndromes and especially when used in shoulder joints. Over 90% of KMDs responded that the safety and efficacy of treatment, specialty, and patients' satisfaction were improved after adopting ultrasound-guidance. Moreover, 94.9% of KMDs agreed with the necessity for reimbursement of ultrasound-guidance in KM under national health insurance coverage. Most KMDs responded that they had positive perceptions regarding the clinical use of ultrasound-guidance in KM in terms of treatment effects, safety, and patient satisfaction, and the need for national health insurance coverage of the service. Our findings may provide practice-based evidence for conducting clinical studies.

Effects of electroacupuncture on obesity: A systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis evaluated the efficacy of electroacupuncture for the treatment of obesity. METHODS: We searched 8 electronic databases for articles published between 2005 and 2021, including only randomized controlled trials (RCTs) in the review. The intervention groups received either electroacupuncture alone or electroacupuncture with standard care, whereas the control groups received sham electroacupuncture, standard care, or no treatment. The primary outcome was the body mass index (BMI), and the secondary outcomes were the body weight (BW), waist circumference (WC), hip circumference, waist-to-hip ratio (WHR), body fat mass, body fat percentage, and adverse effects. Continuous outcome data are presented as mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: This systematic review and meta-analysis included 13 RCTs involving 779 participants. Results revealed that the BMI (MD: -0.98; 95% CI: -1.35 to -0.61), BW (MD: -1.89; 95% CI: -2.97 to -0.80), WC (MD: -2.67; 95% CI: -4.52 to -0.82), and WHR (MD: -0.03; 95% CI: -0.06 to -0.01) were significantly improved in the intervention groups compared with those in the control groups. Adverse effects were reported in 5 studies. The most commonly used acupoint in the abdomen was ST25, whereas the most commonly used acupoints in other regions were ST36 and SP6 for the treatment of obesity. ST25 was the most commonly used acupoint connected by electroacupuncture. CONCLUSION: This systematic review and meta-analysis suggested that electroacupuncture is an effective and safe therapy for simple obesity. To increase the reliability of this study, further detailed, long-term studies should be conducted on the effects of electroacupuncture on obesity.

Effect of Moxibustion Combined with Other Interventions on Body Weight Reduction in the Treatment of Obesity: A Systematic Review and Meta-Analysis.

Background: Moxibustion has been used in the treatment and prevention of obesity. However, there has been no systematic review or meta-analysis conducted on the use of moxibustion on obesity treatment. This study aimed to evaluate the role of moxibustion in the treatment of obesity. Methods: The Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE/PubMed databases were searched to identify all randomized controlled trials (RCTs) that evaluated the effect of moxibustion on obesity. The primary outcome was body weight. The secondary outcomes were the body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR). The risk of bias assessment and meta-analysis were conducted using the Cochrane Collaboration tool. Results: Eleven RCTs involving 761 participants were included in this systematic review and meta-analysis. Other interventions that were included in the analyses were manual acupuncture, electroacupuncture, embedding therapy, herbal medicine, and diet control. Moxibustion combined with other interventions resulted in a significant improvement in body weight reduction (mean difference [MD] -3.32, 95% confidence interval [CI: -4.25 to -2.38]; I2 = 17%), BMI (MD -1.51, 95% CI [-1.88 to -1.14]; I2 = 76%), and WC (MD -2.82, 95% CI [-3.50 to -2.13]; I2 = 75%), but did not improve HC (MD -2.05, 95% CI [-4.21 to 0.11]; I2 = 0%) or WHR (MD -0.01, 95% CI [-0.03 to 0.01]; I2 = 57%). Conclusions: Moxibustion can be used with other interventions to improve body weight, BMI, and WC in people with obesity. However, the conclusions of this review should be cautiously applied to clinical practice because most of the included studies had a high or unclear risk of bias.

Traditional Chinese medicine for foot pain in a patient with complex regional pain syndrome: A case report.

BACKGROUND: Complex regional pain syndrome (CRPS) is characterized by pain as well as sensory, motor, and sudomotor disorders. Generally, it is classified into two types CRPS-I and CRPS-II. There is no single diagnostic test or treatment approach for CRPS, and a multidisciplinary approach is gaining attention to improve patients' symptoms and their quality of life. CASE SUMMARY: A 35-year-old woman with an unremarkable medical history sought treatment for CRPS at a hospital of Korean medicine. During her first visit, she was wheelchair-bound due to severe pain in her left lower extremity. She had edema and discoloration of the left foot. She was treated with a combination of traditional Chinese medicine (TCM) approaches, including acupuncture, moxibustion, pharmacopuncture, and herbal decoction, for approximately 20 sessions. The foot and ankle outcome score (FAOS) and visual analog scale (VAS) score for pain were evaluated, along with general signs and functions. Her symptoms, signs, FAOS, and VAS scores improved after treatment, with a significant 7-degree decrease in the VAS score and a 62-point increase in the FAOS score. Additionally, the foot swelling and discoloration gradually resolved. During the phone follow-up, 5 mo after the last visit, additional improvements in outcomes were observed. CONCLUSION: Combined TCM treatment may be a reasonable and safe option for alleviating symptoms and improving function in patients with CRPS.

Visual bibliometric analysis of electroacupuncture research in stroke treatment: a 20-year overview.

Background: Electroacupuncture has been used as a treatment; however, a visual bibliometric analysis has not yet been performed in this field. In this study, we aimed to suggest future research topics and directions related to the field by examining the last 20 years of research trends and hotspots of electroacupuncture in stroke. Methods: We searched the Web of Science database on electroacupuncture as a treatment for stroke published from 2003 to 2022. We analyzed the papers by annual publication, research fields, nations, affiliations, authors, journals, and keywords. VOSviewer software was used to visualize the bibliometric analysis and results. A total of 440 papers were included in the analysis. Results: The number of publications has gradually increased every year, and neuroscience has become the most actively studied field. Neural Regeneration Research journal and China had the most publications. Fujian University of Traditional Chinese Medicine, as an affiliated institute, published the most articles. Chen Lidian and Tao Jing presented the largest number of papers, making them the leading contributors in this field. Four clusters were created by analyzing keywords, such as "neuroprotection," "clinical rehabilitation," "neuroplasticity," and "pretreatment-induced tolerance". Conclusion: This study is the first to analyze the research trends in electroacupuncture as a treatment for stroke using the VOSviewer. It shows the current state of research in the field by visualizing research trends and hotspots. This will help offer reference data for future studies.

Korean Medicine Clinical Practice Guideline Update for Temporomandibular Disorders: An Evidence-Based Approach.

Many updated clinical research results have been published since the Korean Medicine Clinical Practice Guidelines (KMCPGs) for temporomandibular disorders (TMDs) were published in 2018. Therefore, it is necessary to update the existing clinical practice guidelines (CPGs). This study presents updated recommendations for TMD treatment based on current research data published up to February 2020. The draft version of the level of evidence and grade of recommendation was determined through an assessment of the risk of bias and a meta-analysis of selected literature based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The final guidelines were derived using the Delphi method. Eighteen recommendations were derived for eight items of Korean medicine treatment for TMDs. Compared with previous Korean medicine CPGs for TMDs, the grades of seven recommendations, including acupuncture, pharmacopuncture, and Chuna manual therapy, were increased. The grades of the two recommendations have been changed. Six new recommendations were added to fully reflect clinical reality. Acupuncture, pharmacopuncture, and Chuna manual therapy are recommended for TMD patients in clinical practice. Concurrent conventional conservative therapy with Korean medicine or a combination of Korean medicines should be considered in clinical practice in patients with temporomandibular disorders.

Systematic review and meta-analysis of the anti-obesity effect of cupping therapy.

BACKGROUND: Cupping therapy is a common practice in Korean medicine. Despite developments in this clinical and research area, the current knowledge is insufficient to identify the effects of cupping therapy on obesity. We aimed to assess the effects and safety of cupping therapy on obesity by performing a systematic review and meta-analysis of the effects of cupping therapy. METHODS: A systematic search of databases was conducted, including MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Citation Information by the National Institute of Informatics, KoreaMed, Oriental Medicine Advanced Searching Integrated System, and ScienceON, for full-text randomized controlled trials (RCTs) published through January 14, 2023, with no language restrictions. The experimental groups received cupping therapy combined with traditional Chinese medicine (TCM) and conventional therapy. The control groups received no treatment, conventional therapy, or TCM treatments alone. The experimental and control groups were compared in terms of body weight (BW), body mass index (BMI), hip circumference (HC), waist circumference (WC), waist-hip ratio (WHR), and body fat percentage (BFP). We evaluated the risk of bias using the 7 domains stipulated by the Cochrane Collaboration Group and performed a meta-analysis using Cochrane Collaboration software (Review Manager Software Version 5.3). RESULTS: A total of 21 RCTs were included in this systematic review and meta-analysis. The analysis revealed improvements in BW (P < .001), BMI (P < .001), HC (P = .03), and WC (P < .001). However, there were no clinically significant changes in WHR (P = .65) or BFP (P = .90), both of which had very low certainty of evidence. No adverse events were reported. CONCLUSION: Overall, our results show that cupping therapy can be used to treat obesity in terms of BW, BMI, HC, and WC and is a safe intervention for the treatment of obesity. However, the conclusions of this review should be interpreted with caution in clinical practice because of the uncertain quality of the included studies.

Multiple traditional Chinese medicinal approaches in collaboration with conservative conventional medicine for lumbar herniated intervertebral discs: A systematic review and meta-analysis.

BACKGROUND: This review aimed to verify the clinical effects of traditional Chinese medicine in collaboration with conservative conventional medicine for lumbar herniated intervertebral discs (LHIVD). METHODS: The CENTRAL, EMBASE, MEDLINE/PubMed, JMAS, CNKI, and seven Korean databases were searched using pre-planned strategies. The risk of bias was assessed using the Cochrane Collaboration tool and a meta-analysis was conducted accordingly. RESULTS: Twenty-eight randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. All RCTs included 2746 participants. The experimental group showed more significant improvements in VAS (Mean differences (MD) -1.61, 95% Confidence Intervals (CI) [-2.44, -0.79]; I2 = 98%), Oswestry Disability Index (ODI) (MD -8.52, 95% CI [-11.71, -5.34]; I2 = 96%), and Japanese Orthopaedic Association (JOA) scores (MD 4.83, 95% CI [3.49, 6.17]; I2 = 85%) than the control group. However, the difference in the incidence of adverse events between the experimental and control groups was not significant (Relative Risk (RR) 0.05, 95% CI [0.23, 1.10]; I2 = 46%). CONCLUSION: Traditional Chinese medicine in collaboration with conservative conventional medicine can be used to relieve pain and facilitate better function of the lumbar spine in lumbar herniated intervertebral disc cases. However, this conclusion should be applied with caution in clinical practice owing to the low quality of the included studies.

Association of Dietary Behaviors with Poor Sleep Quality and Increased Risk of Obstructive Sleep Apnea in Korean Military Service Members.

Purpose: Sleep quality among military service members is important for enhancing their capabilities and preventing psychiatric problems. We aimed to explore the association of dietary behaviors with poor sleep quality and increased risk of obstructive sleep apnea (OSA) in military men on active duty. Patients and Methods: A large-scale multi-site cross-sectional survey was conducted in five units of the Republic of Korea's army. Poor sleep quality and increased risk of OSA were defined using the Pittsburgh sleep quality index (PSQI) and Berlin Questionnaire, respectively. Information on dietary behaviors, including the frequency of skipping breakfast, eating snacks, consuming a night meal, and overeating, were collected. Results: From August 2021 to September 2021, 4389 male respondents, mean age (20.8 ± 1.3 years), completed the survey; 2579 (58.8%) were assessed as having poor sleep quality, and 614 (14.0%) increased risk of OSA. After adjusting for lifestyle and occupational covariates, skipping breakfast 1-2 times weekly was associated with an increased likelihood of experiencing poor sleep quality, compared with not skipping breakfast (odds ratio: 1.23 [95% CI 1.02-1.47]). Eating night meals 5-6 times weekly was also associated with poor sleep quality (odds ratio: 5.54 [95% CI 2.49-14.18]). In addition, skipping breakfast daily (odds ratio: 2.28 [95% CI 1.27-4.03]) and eating night meals daily (odds ratio: 2.30 [95% CI 1.21-4.22]) were related to an increased risk of OSA. Conclusion: Dietary behaviors appear to be related to poor sleep quality and a high risk of OSA. To improve sleep quality, dietary factors could be considered when promoting health programs for military personnel in further research.

Fabrication and characterization of 3D printable nanocellulose-based hydrogels for tissue engineering.

Cellulose nanocrystal (CNC)-based hydrogels are considered attractive biomaterials for tissue engineering due to their excellent physicochemical properties. Hydrogels of alginate and gelatin were prepared with or without CNCs and printed using a CELLINK® BIOX 3D bio-printer. The 3D-printed scaffolds were characterized by Fourier transform infrared (FTIR) spectroscopy, Raman spectroscopy, transmission electron microscopy (TEM), and scanning electron microscopy (SEM). Improved mechanical strength was observed in the composite scaffolds compared to the pure polymer scaffolds. Fabricated scaffolds exhibited superior swelling potential; this property is profoundly affected by the CNC content of hydrogels. Biocompatibility of the fabricated scaffolds was monitored in the presence of human bone marrow-derived mesenchymal stem cells (hBMSCs) using the WST-1 assay. Notably, better cell viability was observed in the composite scaffolds than in the control, indicating improved biocompatibility of composites. Cells were healthy and adhered appropriately to the surface of the scaffolds. Mineralization potential of the prepared scaffolds was evaluated by the alizarin red S (ARS) staining technique in the presence of hBMSCs after 7 and 14 days of treatment. Enhanced mineral deposition was observed in the composite scaffolds compared to the control, indicating superior composite mineralization potential. Upregulation of osteogenic-associated genes was observed in the scaffold-treated groups relative to the control, showing superior scaffold osteogenic potential. These results demonstrate that 3D-printed scaffolds are potential candidates for bone tissue engineering applications.

Effects of acupuncture on anthropometric and serum metabolic parameters in premenopausal overweight and obese women: a randomized, patient- and assessor-blind, sham-controlled clinical trial.

OBJECTIVE: The aim of this study was to examine the effect of acupuncture on obesity-related parameters with regard to metabolomics. METHODS: This two-arm parallel, patient- and assessor-blind, sham-controlled randomized clinical trial included 120 obese participants. Participants were randomized into two groups. The treatment group received a combined intervention of manual acupuncture (MA) plus electroacupuncture (EA), while the control group received a combination of sham acupuncture interventions consisting of sham MA plus sham EA for 6 weeks. The serum lipid levels were measured as the primary outcome measure and anthropometric parameters and serum metabolic profiles including amino acids and carnitines were measured as secondary outcome measures. RESULTS: The serum lipid levels and anthropometric measurements did not significantly differ between groups, while body weight, body mass index (BMI), and waist circumference were improved within each group and the level of high-density lipoprotein cholesterol increased over time in the treatment group. There were no significant differences in amino acid levels between groups, while certain carnitine (C2, C4, C6, and l-carnitine) levels were significantly increased (p < 0.05) in the treatment group compared to the control group. CONCLUSION: In summary, 6 weeks of acupuncture treatment did not affect anthropometric and serum metabolic parameters, with the exception of certain carnitines, when compared to sham acupuncture. The observation of increased carnitine levels in the acupuncture group could result in potential long-term benefits to obese individuals. Additional studies are needed to investigate the long-term effects of acupuncture on lipid metabolism and the underlying mechanism of action. TRIAL REGISTRATION NUMBER: This study is registered at ClinicalTrials.gov (NCT02066090).

Stimuli-responsive self-assembly of cellulose nanocrystals (CNCs): Structures, functions, and biomedical applications.

Cellulose nanocrystals (CNCs) have received a significant amount of attention from the researchers. It is used as a nanomaterial for various applications due to its excellent physiochemical properties for the last few decades. Self-assembly is a phenomenon where autonomous reorganization of randomly oriented species occurs elegantly. Self-assembly is responsible for the formation of the hierarchical cholesteric structure of CNCs. This process is highly influenced by several factors, such as the surface chemistry of the nanoparticles, intermolecular forces, and the fundamental laws of thermodynamics. Various conventional experimental designs and molecular dynamics (MD) studies have been applied to determine the possible mechanism of self-assembly in CNCs. Different external factors, like pH, temperature, magnetic/electric fields, vacuum, also influence the self-assembly process in CNCs. Notably, better responses have been observed in CNCs-grafted polymer nanocomposites. These functionalized CNCs with stimuli-responsive self-assembly have immense practical applications in modern biotechnology and medicine. Herein, we have concisely discussed the mechanism of the self-assembled CNCs in the presence of different external factors such as pH, temperature, electric/magnetic fields, and their biomedical applications.

Structural Elucidation and Immune-Enhancing Effects of Novel Polysaccharide from Grifola frondosa.

Beta-glucan (ß-glucan) is a macromolecule structure where glucose unit has bonded through ß-glycosidic bond at 1 and 3 positions. It is well known as a natural immunomodulator without exhibiting any side effects via enhancing immunity. Mushroom contains a large amount of ß-glucan and it has anticancerous and antioxidant efficacy. Structure and physical properties of ß-glucan are highly influenced by the types of mushroom. In particular, Grifola frondosa has ß-1, 3 and ß-1, 6 bonds in their structure. It has been noted that ß-glucan content also depends upon the size of mushroom particles. The exact content of ß-glucan and their immunological activity by a particle size of G. frondosa have yet to be fully elucidated. Herein, ß-glucan contents were analyzed according to the particle size of leaf mushroom followed by cell activation and immunoactivity analysis. The highest ß-glucan content was observed at a particle size of 20-30 µm (27.65 ± 0.30 w/w). All samples showed ~ 103% cell activation compared to the control and greater cell activity was observed at higher concentration. The significant increase in cytokines secretion was observed in the presence of 20-30 µm particle size of G. frondosa compared to the control. This study suggested that 20-30 µm size is the suitable size of G. frondosa that can be used as a health supplement and food additive to act as an immune booster, hypotensive agent, and hypoglycemic agent.

Effect and neurophysiological mechanism of acupuncture in patients with chronic sciatica: protocol for a randomized, patient-assessor blind, sham-controlled clinical trial.

BACKGROUND: Sciatica is a relatively frequent illness that easily becomes a chronic and relapsing condition. Although numerous systematic reviews have analyzed various therapies for sciatica, the validity of their included studies is limited. Considering the limitations of conventional treatment options for sciatica, acupuncture is a possible option; however, evidence supporting its efficacy and mechanism in patients with sciatica is lacking. The aim of this proposed protocol is to investigate the effect and neurophysiological mechanism of acupuncture in patients with chronic sciatica. METHODS/DESIGN: This study is a randomized, patient-assessor blind, two-arm, parallel, non-penetrating, sham-controlled clinical trial. Eligible participants will include adults (aged 19-70 years old) with a clinical diagnosis of chronic sciatica (40 mm or more of a 100-mm visual analog scale (VAS) for bothersomeness) blinded to the treatment received. Patients will be randomly allocated into the acupuncture treatment group (manual acupuncture plus electroacupuncture (EA), n = 34) or the sham acupuncture control group (sham acupuncture plus placebo EA without electrical stimulation, n = 34). Groups will receive treatment twice a week for a total of eight sessions over 4 weeks. Functional magnetic resonance imaging will be implemented at baseline and endpoint to investigate the mechanism of acupuncture. The primary outcome measure is the VAS for bothersomeness and secondary outcomes include the VAS for pain intensity, Oswestry Disability Index, EuroQol 5-Dimension, Coping Strategy Questionnaire, Beck's Depression Inventory, and State-Trait Anxiety Inventory. Adverse events will be assessed at every visit. DISCUSSION: The results of this trial (which will be available in 2020) should provide important clinical evidence for the effect of acupuncture and demonstrate how acupuncture can be helpful for the treatment of chronic sciatica. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03350789 . Registered on 15 November 2017.

Haptic simulation for acupuncture needle manipulation.

BACKGROUND: Stimulation degree, biomechanical force, and de qi sensation are the three major components of needle manipulation. To date, it has been difficult to measure all three components quantitatively. OBJECTIVES: To (1) measure and compare biomechanical forces of six human acupoints in vivo during haptic manipulation, (2) develop phantom acupoints with biomechanical forces similar to those of human acupoints, and (3) validate the newly developed phantom acupoints based on assessment by doctors of Korean medicine. METHODS: The biomechanical force and needle grasp sensation (i.e., the practitioner's de qi sensation) of six human acupoints (LI4, LI11, LR3, ST36, ST25, and BL25) were assessed in 16 participants upon stimulation with the twisting manipulation technique. On the basis of biomechanical data from these human acupoints, phantom acupoints that generated similar biomechanical forces were developed by using 1%-7% agarose gel. RESULTS: In humans, the mean torque amplitudes of the six acupoints differed significantly. In the phantom, the biomechanical force was dose-dependently greater in higher-concentration agarose gel phantom acupoints. Biomechanical force and the needle grasp sensation were significantly correlated in both human and phantom acupoints. Importantly, practitioners could not discriminate between human and phantom acupoints, suggesting that the validity and credibility of the phantom acupoints are sufficient for applications in education and research. CONCLUSIONS: Application of force-validated phantom acupoints based on human data will be a helpful tool for training and will contribute to a more comprehensive understanding of the characteristics of acupuncture manipulation.

Hypoxia-mediated mechanism of MUC5AC production in human nasal epithelia and its implication in rhinosinusitis.

BACKGROUND: Excessive mucus production is typical in various upper airway diseases. In sinusitis, the expression of MUC5AC, a major respiratory mucin gene, increases. However, the mechanisms leading to mucus hypersecretion in sinusitis have not been characterized. Hypoxia due to occlusion of the sinus ostium is one of the major pathologic mechanisms of sinusitis, but there have been no reports regarding the mechanism of hypoxia-induced mucus hypersecretion. METHODS AND FINDINGS: This study aims to identify whether hypoxia may induce mucus hypersecretion and elucidate its mechanism. Normal human nasal epithelial (NHNE) cells and human lung mucoepidermoid carcinoma cell line (NCI-H292) were used. Sinus mucosa from patients was also tested. Anoxic condition was in an anaerobic chamber with a 95% N2/5% CO2 atmosphere. The regulatory mechanism of MUC5AC by anoxia was investigated using RT-PCR, real-time PCR, western blot, ChIP, electrophoretic mobility shift, and luciferase assay. We show that levels of MUC5AC mRNA and the corresponding secreted protein increase in anoxic cultured NHNE cells. The major transcription factor for hypoxia-related signaling, HIF-1α, is induced during hypoxia, and transfection of a mammalian expression vector encoding HIF-1α results in increased MUC5AC mRNA levels under normoxic conditions. Moreover, hypoxia-induced expression of MUC5AC mRNA is down-regulated by transfected HIF-1α siRNA. We found increased MUC5AC promoter activity under anoxic conditions, as indicated by a luciferase reporter assay, and mutation of the putative hypoxia-response element in MUC5AC promoter attenuated this activity. Binding of over-expressed HIF-1α to the hypoxia-response element in the MUC5AC promoter was confirmed. In human sinusitis mucosa, which is supposed to be hypoxic, expression of MUC5AC and HIF-1α is higher than in control mucosa. CONCLUSION: The results indicate that anoxia up-regulates MUC5AC by the HIF-1α signaling pathway in human nasal epithelia and suggest that hypoxia might be a pathogenic mechanism of mucus hypersecretion in sinusitis.

Distally based adipofascial flaps covering soft-tissue defects of the dorsal foot and ankle in children.

Dorsal soft-tissue defects of the foot and ankle are difficult to cover adequately, particularly in children, although multiple options for reconstruction are available. This study reports the long-term clinical outcomes of the use of distally based adipofascial flaps for these injuries in children. Fourteen children, all younger than 9 years, had relatively homogenous local lesions on the dorsum of the foot and ankle or on the distal lower leg. All 14 defects were covered with distally based adipofascial flaps, either lateral supramalleolar flaps (11 cases) or sural flaps (3 cases), after thorough wound debridement. The minimum follow-up interval was 5 years. The appearance of the reconstructed feet aesthetically and functionally satisfied the patients and their parents. Some patients exhibited a growth mismatch between grafted skin and the recipient site, resulting in mild extension contracture of the metatarsophalangeal joints; however, motion of the ankle joints was excellent.

A modified midfacial degloving approach for the treatment of unilateral paranasal sinus tumours.

PURPOSE: The midfacial degloving approach (MFDA) is the primary option for the removal of benign and malignant sinonasal tumours. However, the classic MFDA does not compensate for the fact that most benign and malignant paranasal sinus (PNS) tumours are unilateral and the incisions may lead to some unnecessary complications?. Surgical exposure is limited to the upper and deep part of the PNS. Modifications of the classical MFDA that minimize complications and improve surgical field exposure are warranted. PATIENTS: The medical records of 27 consecutive patients who had undergone surgery using a modified MFDA for treatment of unilateral benign or malignant tumours from 2000 to 2006, were reviewed. RESULTS: We developed and performed a modified MFDA utilizing a hemigingivobuccal incision, a transfixion incision, mucosal detachment of the pyriform aperture and separation of the upper lateral cartilage from the nasal bone in 27 patients with unilateral benign (85%) or malignant (15%) PNS neoplasms. Adequate surgical exposure was achieved in all cases. No technical problems and no intraoperative complications related to the surgical procedure were encountered. CONCLUSION: Our modified MFDA provides sufficient surgical exposure for the removal of unilateral malignant or benign PNS tumours with few surgical or cosmetic complications.