Maximum diameter versus volumetric assessment for the response evaluation of vestibular schwannomas receiving stereotactic radiotherapy.

PURPOSE: To explore the feasibility of maximum diameter as a response assessment method for vestibular schwannomas (VS) after stereotactic radiosurgery or fractionated stereotactic radiotherapy (RT), we analyzed the concordance of RT responses between maximum diameters and volumetric measurements. Materials and. METHODS: Forty-two patients receiving curative stereotactic radiosurgery or fractionated stereotactic RT for VS were analyzed retrospectively. Twelve patients were excluded: 4 did not receive follow-up magnetic resonance imaging (MRI) scans and 8 had initial MRI scans with a slice thickness >3 mm. The maximum diameter, tumor volume (TV), and enhanced tumor volume (ETV) were measured in each MRI study. The percent change after RT was evaluated according to the measurement methods and their concordances were calculated with the Pearson correlation. The response classifications were determined by the assessment modalities, and their agreement was analyzed with Cohen kappa statistics. RESULTS: Median follow-up was 31.0 months (range, 3.5 to 86.5 months), and 90 follow-up MRI studies were analyzed. The percent change of maximum diameter correlated strongly with TV and ETV (r(p) = 0.85, 0.63, p = 0.000, respectively). Concordance of responses between the Response Evaluation Criteria in Solid Tumors (RECIST) using the maximum diameters and either TV or ETV were moderate (kappa = 0.58; 95% confidence interval, 0.32-0.85) or fair (kappa = 0.32; 95% confidence interval, 0.05-0.59), respectively. Conclusions: The percent changes in maximum diameter and the responses in RECIST were significantly concordant with those in the volumetric measurements. Therefore, the maximum diameters can be used for the response evaluation of VS following stereotactic RT.

Efficacy of ethanol ablation for thyroglossal duct cyst.

OBJECTIVE: Ethanol ablation has been known as an effective, easy, and safe treatment of cystic thyroid lesions. The objective of the present study was to evaluate efficacy of ethanol ablation as a minimally invasive management of thyroglossal duct cyst (TGDC). METHODS: Between January 2012 and July 2013, 9 TGDC patients were diagnosed and treated with ethanol ablation. We evaluated the treatment outcomes with the change of volume reduction and the improvement of symptomatic and cosmetic complaints and complications. RESULTS: Initial mean tumor volume was 8.9 mL (range, 0.2-36.9 mL) in ultrasonography. The mean number of the treatment sessions was 1.7 (range, 1-3 sessions). At last follow-up, the mean volume of the treated thyroglossal duct cyst decreased significantly from 8.9 mL to 1.9 mL (P = .019; volume reduction rate = 76.6%). Treatment success rate was 77.8% (7/9). Mean symptoms and cosmetic-grading scores improved from 5.2 to 3.1 and from 5.3 to 3.1 (P = .062). No significant complications were observed during follow-up. CONCLUSION: Ethanol ablation is a feasible and convenient procedure without surgical scars and hospitalization for TGDC patients. Favorable outcomes can be achieved without significant complications.

Fabrication of high performance thin-film transistors via pressure-induced nucleation.

We report a method to improve the performance of polycrystalline Si (poly-Si) thin-film transistors (TFTs) via pressure-induced nucleation (PIN). During the PIN process, spatial variation in the local solidification temperature occurs because of a non-uniform pressure distribution during laser irradiation of the amorphous Si layer, which is capped with an SiO2 layer. This leads to a four-fold increase in the grain size of the poly-Si thin-films formed using the PIN process, compared with those formed using conventional excimer laser annealing. We find that thin films with optimal electrical properties can be achieved with a reduction in the number of laser irradiations from 20 to 6, as well as the preservation of the interface between the poly-Si and the SiO2 gate insulator. This interface preservation becomes possible to remove the cleaning process prior to gate insulator deposition, and we report devices with a field-effect mobility greater than 160 cm(2)/Vs.

Dexamethasone Induces Apoptosis of Nasal Polyp-Derived Tissue Cultures Through JNK and p38 MAPK Activation.

OBJECTIVES: Glucocorticoids, such as dexamethasone (DEX), increase apoptosis in a variety of white cells in nasal polyps and apoptosis is an important factor in the resolution of inflammation. However, the mechanism of glucocorticoids induced apoptosis in nasal polyp remains unclear. In this study the authors evaluated which pathways were engaged in apoptosis induced by DEX in an ex vivo model of nasal polyps. METHODS: Nasal polyp tissues were cultured using an air-liquid interface method. Cultures were maintained in the absence or presence of DEX (10 or 100 µM) for 24 hours. To investigate the involvement of the apoptotic signaling pathways in nasal polyp, such as caspase cascades, Fas-FasL signaling pathway, mitochondrial pathway and p38 mitogen-activated protein kinase (MAPK)/JNK pathway, the authors performed reverse transcription-polymerase chain reaction and Western blotting. RESULTS: The expression ratios of FasL, activated form of caspase-8, caspase-9, and caspase-3 were significantly higher in DEX-treated polyps (P<0.01). In the Bcl-2 family expression, the anti-apoptotic molecules, Bcl-2 and Bcl-XL decreased, but pro-apoptotic molecules, Bax increased, and Bid and Bad were activated. In the conventional MAPKs, JNK, and the phospho-p38 MAPK were significantly higher, but phospho-extracellular signal-regulated kinase (ERK)1/2 was significantly lower in DEX-treated polyps (P<0.01). CONCLUSION: DEX induces apoptosis of nasal polyp via caspase cascades, Fas-FasL signaling pathway, mitochondrial pathway and p38 MAPK/JNK pathway.

Recombinant human BMP-2 enhances osteogenesis of demineralized bone matrix in experimental mastoid obliteration.

CONCLUSIONS: From the results, recombinant human bone morphogenic protein 2 (rhBMP-2) activated demineralized bone matrix (DBM) for the enhancement of bone regeneration. These results might provide a basis for the clinical application of BMP-2 in mastoid obliteration. OBJECTIVE: The purpose of this study was to evaluate the enhanced osteogenesis of rhBMP-2-loaded DBM using a gelatin sponge in the mastoid obliteration model. METHODS: The bulla obliteration was done using rhBMP-2 (0.075 mg/ml)/DBM in experimental group I (n = 7) and rhBMP-2 (0.375 mg/ml)/DBM in experimental group II (n = 7). In the control group (n = 7), the bullae were obliterated using PBS/DBM. To assess the active mineralization of new bone formation, each group received intravenous calcein blue at 4 weeks, oxytetracycline hydrochloride at 8 weeks, and alizarin red at 10 weeks. The animals in each group were sacrificed 12 weeks post-surgery. Osteogenesis was evaluated by in vivo CT and histological observation. RESULTS: The largest amount of bone had formed in experimental group II compared with other groups according to CT and histopathological findings. Histomorphometric analysis showed that there were significant differences between each group. Confocal microscopic findings revealed that three distinct colors that corresponded to sequential osteogenesis were observed in group II. However, poor sequential osteogenesis was observed in the control group.

Alternative to canal wall-down mastoidectomy for sclerotic mastoid cavities: epitympanoplasty with mastoid obliteration.

OBJECTIVES: Surgical procedures for chronic ear disease can be grossly divided into two tympanoplasty procedures: canal wall-up and canal wall-down (CWD) mastoidectomies. The choice depends on the surgeon's preference. Epitympanoplasty with mastoid obliteration (EMO) has shown postoperative results similar to those of CWD mastoidectomy with long-term follow-up. In this study, we compared the outcomes of EMO and CWD mastoidectomy in preoperatively sclerotic mastoid cavities with cholesteatoma, chronic otitis media with poor eustachian tube function, or adhesive otitis media. The operations were performed by the same surgeons in order to eliminate any effect of surgeon preference on the surgical outcomes. METHODS: We reviewed the medical records of patients who underwent tympanoplasty with EMO (EMO group) or CWD mastoidectomy (CWD group) and followed them for more than 28 months. The postoperative outcomes were analyzed and compared. RESULTS: The EMO and CWD groups comprised 132 and 110 ears, respectively. In both groups, the air-bone gaps were significantly reduced after operation. The relapse rates of the groups were similar. Cavity problems were the most common complication in the CWD group. The overall complication rate in the EMO group was significantly lower than that in the CWD group (p = 0.044). CONCLUSIONS: Epitympanoplasty with mastoid obliteration can be considered an alternative procedure to CWD mastoidectomy in patients with preoperatively sclerotic mastoid cavities. It gives similar surgical results and has fewer complications.

The relationship between the BRAF(V600E) mutation in papillary thyroid microcarcinoma and clinicopathologic factors.

BACKGROUND: The BRAF(V600E) mutation, which accounts for about 60-80% papillary thyroid carcinoma(PTC), has been identifiedas a prognostic marker for risk stratification of PTC patients. However, the BRAF(V600E) mutation as a prognostic marker in papillary thyroid microcarcinoma (PTMC) is unclear. METHODS: We performed a retrospective review of 101 patients who underwent surgery for PTMC. We studied the prevalence of the BRAF(V600E) mutation. The associations between the BRAF(V600E) mutation and clinicopathologic characteristics were analyzed. RESULTS: The BRAF(V600E) mutation was observed in 72 patients (71.3%). There was no statistically significant correlation in age, gender, multifocality, extrathyroidal extension, presence of Hashimoto thyroiditis, and lymph node metastasis between the BRAF(V600E) mutant group and wild group. CONCLUSIONS: The BRAF(V600E) mutation is not significantly associated with prognostic factors in PTMC.

Formation of silicon nanoparticles by a pressure induced nucleation mechanism.

Formation of silicon nanoparticles (SiNPs) was achieved using excimer laser crystallization of an amorphous Si (a-Si) thin film using a SiO2 capping layer (C/L) with improved thin-film transistor (TFT) performance due to the enlarged grain size of polycrystalline Si (poly-Si). After laser irradiation of an a-Si thin film covered with C/L, fluctuation in the surface morphology of the C/L was observed above the critical laser energy density (Ecr) with the formation of SiNPs. The grain size of the poly-Si layer after crystallization increased abruptly at the same time. A non-uniform pressure distribution beneath the SiO2 C/L was proposed for the initiation of nucleation, which is named pressure induced nucleation (PIN) mechanism. Following nucleation, the release of latent heat made it difficult for the remnant liquid Si to solidify and the volume increased due to the density difference between the liquid and solid Si. Consequently, the pressure on the liquid Si caused SiNPs to sprout through the SiO2 C/L as grains grew from the low temperature to high temperature point. This study offers not only a simple method to fabricate SiNPs with controllable size/density but also larger grain size with lower laser energy density, which leads to higher TFT performance.

Clinical efficacy of initial intratympanic steroid treatment on sudden sensorineural hearing loss with diabetes.

OBJECTIVE: The purpose of this study is to compare the efficacy of intratympanic steroid injection (ITSI) with that of systemic steroids as an initial treatment of sudden sensorineural hearing loss (SNHL) with diabetes. STUDY DESIGN: Prospective, nonrandomized multicenter clinical trial. SETTING: Multicenter study in Busan and Masan, South Korea. SUBJECTS AND METHODS: A total of 114 sudden SNHL patients who were diagnosed with diabetes were divided into peroral (PO) group (n = 48), intravenous (IV) group (n = 32), and intratympanic (IT) group (n = 34). In the PO group, prednisolone was used orally for 10 days, per schedule. In the IV group, prednisolone was administered intravenously for seven days, followed by oral administration of tapered doses for another several days. In the IT group, dexamethasone was injected into the tympanic cavity four times within a two-week period. Hearing outcome was assessed before and after the treatment. RESULTS: All groups showed significant improvement with criteria of 15 dB (P < 0.05). However, there was no significant difference in hearing gain and recovery rate among groups (P > 0.05). Systemic steroid treatment was stopped for two patients in the IV group and for one in the PO group due to uncontrolled hyperglycemia. However, in the IT group, there were no patients who failed to control their blood sugar level. CONCLUSION: ITSI is as effective as systemic steroid treatment for sudden SNHL patients with diabetes and it can avoid undesirable side effects. Therefore, we consider ITSI to be a more reasonable alternative as an initial treatment for sudden SNHL patients with diabetes.

Epitympanoplasty with mastoid obliteration technique: a long-term study of results.

OBJECTIVE: To report the long-term results of epitympanoplasty with mastoid obliteration technique. SUBJECTS AND METHODS: Two hundred adult cases had undergone epitympanoplasty with mastoid obliteration from December 1994 to May 2003. The mean postoperative observation period was 91 months, with a minimum of five years. Epitympanoplasty with mastoid obliteration technique has four major procedures: the widening of the external auditory canal and removal of the scutum; preservation of the posterior canal wall; epitympanoplasty; and mastoid obliteration. We examined postoperative complications and hearing outcomes. RESULTS: There was no retraction pocket formation and recurrence of cholesteatoma. Residual cholesteatoma in the tympanic cavity was seen in 10 cases (5%) and three cases were seen in the mastoid cavity (1.5%). Other complications were otorrhea (15 cases), perforation (8 cases), material extrusion (6 cases), and posterior auricular infection (4 cases). The average preoperative pure tone air-bone gap, postoperative pure tone air-bone gap, and air-bone gap closure were 31.5 +/- 12.4 dB, 25.3 +/- 12.2 dB, and 6.2 +/- 12.6 dB, respectively. There were significant differences between the preoperative and postoperative values (P < 0.01). CONCLUSIONS: The authors believe that epitympanoplasty with mastoid obliteration technique can combine the advantages of canal wall down and canal wall up techniques while improving their shortcomings.

Relationship between bone mineral density and clinical features in women with idiopathic benign paroxysmal positional vertigo.

OBJECTIVE: To evaluate the relationship between bone mineral density (BMD) and clinical features in women with idiopathic benign paroxysmal positional vertigo (IBPPV). STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Patients with BMD measurements made after a diagnosis of IBPPV were included. The IBPPV (n = 78) and control groups (n = 177) were divided into ordinal age categories of similar size. Group A (n = 20) patients were aged 20 to 39 years, Group B (n = 21) patients were aged 40 to 49 years, Group C (n = 18) patients were aged 50 to 59 years, and Group D (n = 19) patients were aged 60 to 69 years. INTERVENTIONS: In each age range, the BMD values were compared according to the number of canalith repositioning maneuvers (CRMs) or the presence of recurrence. We divided all patients into 2 groups with the normal and abnormal BMD values and compared both groups based on the number of CRMs or the frequency of recurrence. MAIN OUTCOME MEASURES: The BMD value, the number of CRMs, and the presence of recurrence. RESULTS: In Groups A, B, and C, there was a significant difference in the BMD values between the control, 1-visit, and 2-or-more-visits subgroups. In Group D, the 2-or-more-visits subgroup had a lower BMD value than other subgroups. The difference in the number of CRMs between the normal and abnormal BMD groups was significant. In Groups A and B, there was a significant difference in the BMD values between the control, first-attack, and recurrent-attacks subgroups. In Groups C and D, the recurrent-attacks subgroup had lower BMD values than other subgroups. The difference in the frequency of recurrence between the normal and abnormal BMD groups was significant. CONCLUSION: Patients with IBPPV had lower BMD values compared with control subjects, and patients with low BMD values showed a significant increase in the number of CRMs required and the recurrence rate.

Pro-apoptotic effect of high concentrations of histamine on human neutrophils.

Histamine receptors are expressed on neutrophils, and therefore, are likely to modulate neutrophil function. In this study, we investigated whether histamine modulates human neutrophil survival. Neutrophils were found to rapidly undergo spontaneous apoptosis upon culture in vitro and this was accelerated by high concentrations of histamine. Moreover, the percentage of apoptotic neutrophils was also markedly increased by treating with 10 mM histamine in the presence of inflammatory mediators, such as lipopolysaccharide (LPS), granulocyte macrophage-colony stimulating factor (GM-CSF), dibutyryl-cAMP (db-cAMP), or dexamethasone. Histamine-induced neutrophil apoptosis was inhibited by pyrilamine, a histamine receptor 1 antagonist, and by ranitidine, a selective histamine receptor 2 antagonist. In addition, diphenylene iodonium (DPI), an inhibitor of NADPH-oxidase, significantly blocked the apoptotic effect of histamine. Moreover, the induction of apoptosis by histamine was almost completely inhibited by zVAD-fmk, a pan-caspase inhibitor. In addition, immunoblotting showed that histamine induced the proteolytic activation of procaspase-3 in cell lysates treated with histamine. And, the protein kinase C (PKC)-delta inhibitor, rottlerin (5 microM) significantly blocked the apoptotic effect of histamine, though the cleavage of PKC-delta in 20 h cultured neutrophils was increased by histamine. However, an inhibitor of conventional PKC, Go6976 (100 nM) and a p38 mitogen-activated protein kinase inhibitor, SB203580 (10 microM), failed to block histamine-induced neutrophil apoptosis. These results suggest that high concentrations of histamine in local inflammatory and allergic lesions induce neutrophil apoptosis, and that this histamine-induced apoptosis is mediated by caspase activation and PKC-delta signaling.