Code-Free Machine Learning Approach for EVO-ICL Vault Prediction: A Retrospective Two-Center Study.

Purpose: Establishing a development environment for machine learning is difficult for medical researchers because learning to code is a major barrier. This study aimed to improve the accuracy of a postoperative vault value prediction model for implantable collamer lens (ICL) sizing using machine learning without coding experience. Methods: We used Orange data mining, a recently developed open-source, code-free machine learning tool. This study included eye-pair data from 294 patients from the B&VIIT Eye Center and 26 patients from Kim's Eye Hospital. The model was developed using OCULUS Pentacam data from the B&VIIT Eye Center and was internally evaluated through 10-fold cross-validation. External validation was performed using data from Kim's Eye Hospital. Results: The machine learning model was successfully trained using the data collected without coding. The random forest showed mean absolute errors of 124.8 µm and 152.4 µm for the internal 10-fold cross-validation and the external validation, respectively. For high vault prediction (>750 µm), the random forest showed areas under the curve of 0.725 and 0.760 for the internal and external validation datasets, respectively. The developed model performed better than the classic statistical regression models and the Google no-code platform. Conclusions: Applying a no-code machine learning tool to our ICL implantation datasets showed a more accurate prediction of the postoperative vault than the classic regression and Google no-code models. Translational Relevance: Because of significant bias in measurements and surgery between clinics, the no-code development of a customized machine learning nomogram will improve the accuracy of ICL implantation.

Phosphorus-Ligand Redox Cooperative Catalysis: Unraveling Four-Electron Dioxygen Reduction Pathways and Reactive Intermediates.

The reduction of dioxygen to water is crucial in biology and energy technologies, but it is challenging due to the inertness of triplet oxygen and complex mechanisms. Nature leverages high-spin transition metal complexes for this, whereas main-group compounds with their singlet state and limited redox capabilities exhibit subdued reactivity. We present a novel phosphorus complex capable of four-electron dioxygen reduction, facilitated by unique phosphorus-ligand redox cooperativity. Spectroscopic and computational investigations attribute this cooperative reactivity to the unique electronic structure arising from the geometry of the phosphorus complex bestowed by the ligand. Mechanistic study via spectroscopic and kinetic experiments revealed the involvement of elusive phosphorus intermediates resembling those in metalloenzymes. Our result highlights the multielectron reactivity of phosphorus compound emerging from a carefully designed ligand platform with redox cooperativity. We anticipate that the work described expands the strategies in developing main-group catalytic reactions, especially in small molecule fixations demanding multielectron redox processes.

Deep learning algorithm for the automated detection and classification of nasal cavity mass in nasal endoscopic images.

Nasal endoscopy is routinely performed to distinguish the pathological types of masses. There is a lack of studies on deep learning algorithms for discriminating a wide range of endoscopic nasal cavity mass lesions. Therefore, we aimed to develop an endoscopic-examination-based deep learning model to detect and classify nasal cavity mass lesions, including nasal polyps (NPs), benign tumors, and malignant tumors. The clinical feasibility of the model was evaluated by comparing the results to those of manual assessment. Biopsy-confirmed nasal endoscopic images were obtained from 17 hospitals in South Korea. Here, 400 images were used for the test set. The training and validation datasets consisted of 149,043 normal nasal cavity, 311,043 NP, 9,271 benign tumor, and 5,323 malignant tumor lesion images. The proposed Xception architecture achieved an overall accuracy of 0.792 with the following class accuracies on the test set: normal = 0.978 ± 0.016, NP = 0.790 ± 0.016, benign = 0.708 ± 0.100, and malignant = 0.698 ± 0.116. With an average area under the receiver operating characteristic curve (AUC) of 0.947, the AUC values and F1 score were highest in the order of normal, NP, malignant tumor, and benign tumor classes. The classification performances of the proposed model were comparable with those of manual assessment in the normal and NP classes. The proposed model outperformed manual assessment in the benign and malignant tumor classes (sensitivities of 0.708 ± 0.100 vs. 0.549 ± 0.172, 0.698 ± 0.116 vs. 0.518 ± 0.153, respectively). In urgent (malignant) versus nonurgent binary predictions, the deep learning model achieved superior diagnostic accuracy. The developed model based on endoscopic images achieved satisfactory performance in classifying four classes of nasal cavity mass lesions, namely normal, NP, benign tumor, and malignant tumor. The developed model can therefore be used to screen nasal cavity lesions accurately and rapidly.

Development of a Machine-Learning-Based Tool for Overnight Orthokeratology Lens Fitting.

Purpose: Orthokeratology (ortho-K) is widely used to control myopia. Overnight ortho-K lens fitting with the selection of appropriate parameters is an important technique for achieving successful reductions in myopic refractive error. In this study, we developed a machine-learning model that could select ortho-K lens parameters at an expert level. Methods: Machine-learning models were established to predict the optimal ortho-K parameters, including toric lens option (toric or non-toric), overall diameter (OAD; 10.5 or 11.0 mm), base curve (BC), return zone depth (RZD), landing zone angle (LZA), and lens sagittal depth (LensSag). The analysis included 547 eyes of 297 Korean adolescents with myopia or astigmatism. The dataset was randomly divided into training (80%, n = 437 eyes) and validation (20%, n = 110 eyes) sets at the patient level. The model was trained based on clinical ortho-K lens fitting performed by highly experienced experts and ophthalmic measurements. Results: The final machine-learning models showed accuracies of 92.7% and 86.4% for predicting the toric lens option and OAD, respectively. The mean absolute errors for the BC, RZD, LZA, and LensSag predictions were 0.052 mm, 2.727 µm, 0.118°, and 5.215 µm, respectively. The machine-learning model outperformed the manufacturer's conventional initial lens selector in predicting BC and RZD. Conclusions: We developed an expert-level machine-learning-based model for determining comprehensive ortho-K lens parameters. We also created a web-based application. Translational Relevance: This model may provide more accurate fitting parameters for lenses than those of conventional calculations, thus reducing the need to rely on trial and error.

Molecular and Treatment Characteristics of SMARCB1 or SMARCA4-Deficient Undifferentiated Tumor: Retrospective Case Series.

SMARCB1 or SMARCA4-deficient sinonasal carcinoma or thoracic undifferentiated tumor has aggressive nature with a poor prognosis. Patients with this disease were diagnosed by immunohistochemistry (IHC) or next-generation sequencing (NGS). Those who were able to receive a surgery tended to be cured, while the others treated with chemotherapy, radiation therapy, or immune checkpoint inhibitor were often insensitive to these therapies. However, one having CD274 (PD-L1) amplification showed the response to immune checkpoint inhibitor and a good prognosis. We believed that this report could provide promising information for determining the optimal treatment option.

Trophic assessment of red seabream (Pagrus major) as a possible bioindicator of human activities in the South Sea of Korea using stable C and N isotopes.

To assess the impact of sand mining on resource utilization by the red seabream (Pagrus major) and the trophic structure of fish assemblages two years after mining activities, we compared stable isotope ratios (δ13C and δ15N) and isotopic niches between aggregated mining and control sites in April and August 2022. Our results showed no spatial differences in the δ13C and δ15N values of red seabream between the sand mining and control sites, suggesting that the mining did not affect their dietary resources. Furthermore, the considerable overlap among fish consumers suggested that the fish food web in mining areas has trophic functions similar to those in natural habitats after mining activities. Overall, our study enhances our understanding of ecosystem conservation and the ecological-based management of coastal areas.

Treatment Outcome of Olfactory Neuroblastoma: A Multicenter Study by the Korean Sinonasal Tumor and Skull Base Surgery Study Group.

Objectives: Due to the rarity of olfactory neuroblastoma (ONB), there is an ongoing debate about optimal treatment strategies, especially for early staged or locally advanced cases. Therefore, our study aims to explore experiences from multiple centers, focusing on factors that influence the oncological outcomes of ONB. Methods: We retrospectively analyzed 195 ONB patients treated at nine tertiary hospitals in South Korea between December 1992 and December 2019. Kaplan-Meier survival analysis was used to evaluate oncological outcomes, and the Cox proportional hazards regression model was employed to analyze prognostic factors for survival outcomes. Furthermore, we conducted 1:1 nearest-neighbor matching to investigate differences in clinical outcomes according to the use of neoadjuvant chemotherapy. Results: In our cohort, the 5-year overall survival rate (OS) was 78.6%, and the 5-year disease-free survival rate (DFS) was 62.4%. The Cox proportional hazards model revealed that the mKadish stage and Dulguerov T status were significant for DFS, while the mKadish stage and Hyams grade were identified as prognostic factors for OS. The subgroup analyses indicated a trend toward improved 5-year DFS with dural resection in mKadish A and B cases, even though that result was statistically insignificant. Induction chemotherapy did not provide a survival benefit in this study after matching for the mKadish stage and nodal status. Conclusion: Clinical staging and pathologic grading are important prognostic factors in ONB. Dural resection in mKadish A and B did not show a significant survival benefit. Induction chemotherapy did not show a survival benefit, even after stage matching.

Treatment outcome and prognostic factors of inverted papilloma involving the frontal sinus.

Objectives: This study aimed to evaluate the characteristics and treatment outcomes of inverted papillomas involving the frontal sinus. Methods: Patients treated for inverted papilloma involving the frontal sinus between 2003 and 2020 were reviewed. Tumors were classified based on their extent (Extent 1: partially encroaching on the frontal sinus; Extent 2: completely filling the frontal sinus; Extent 3: eroding bony borders beyond the frontal sinus) and site of origin (Origin 1: originating outside the frontal sinus and prolapsing into the frontal sinus; Origin 2: originating from the frontal sinus walls medial to the vertical plane of the lamina papyracea; Origin 3: originating from the frontal sinus walls lateral to the vertical plane of the lamina papyracea). Treatment outcomes including tumor recurrence and patency of the frontal recess were analyzed according to tumor characteristics and surgical treatment modalities. Results: A total of 49 surgical cases were analyzed. Extent 1 were the most common type (n = 27), followed by Extent 2 (n = 15), and Extent 3 (n = 7). The most common sites of origin were Origin 1 (n = 23), followed by Origin 2 (n = 15), and Origin 3 (n = 11). Overall, there were nine recurrences (18.4%). Recurrence was not associated with tumor extent, whereas tumor origin, particularly Origin 3 was associated with higher recurrence; 1/23 (4.3%) for Origin 1, 3/15 (20.0%) for Origin 2, and 5/11 (45.5%) for Origin 3 (Log-rank p < .001). Draf III frontal sinusotomy was associated with in the highest patency rate (84.6%) during the follow-up. Conclusion: The recurrence rate of frontal sinus inverted papilloma depends on tumor origin rather than the extent of the tumor. In particular, lesions originating from the frontal sinus lateral to the lamina papyracea recur frequently. Draf III frontal sinusotomy can achieve patent frontal recess allowing active surveillance. Level of Evidence: IV.

Innate Immune Training Initiates Efferocytosis to Protect against Lung Injury.

Innate immune training involves myelopoiesis, dynamic gene modulation, and functional reprogramming of myeloid cells in response to secondary heterologous challenges. The present study evaluates whether systemic innate immune training can protect tissues from local injury. Systemic pretreatment of mice with ß-glucan, a trained immunity agonist, reduces the mortality rate of mice with bleomycin-induced lung injury and fibrosis, as well as decreasing collagen deposition in the lungs. ß-Glucan pretreatment induces neutrophil accumulation in the lungs and enhances efferocytosis. Training of mice with ß-glucan results in histone modification in both alveolar macrophages (AMs) and neighboring lung epithelial cells. Training also increases the production of RvD1 and soluble mediators by AMs and efferocytes. Efferocytosis increases trained immunity in AMs by stimulating RvD1 release, thus inducing SIRT1 expression in neighboring lung epithelial cells. Elevated epithelial SIRT1 expression is associated with decreased epithelial cell apoptosis after lung injury, attenuating tissue damage. Further, neutrophil depletion dampens the effects of ß-glucan on macrophage accumulation, epigenetic modification in lung macrophages, epithelial SIRT1 expression, and injury-mediated fibrosis in the lung. These findings provide mechanistic insights into innate immune training and clues to the potential ability of centrally trained immunity to protect peripheral organs against injury-mediated disorders.

Implications for Combination Therapy of Selective Monoamine Reuptake Inhibitors on Dopamine Transporters.

Monoamine transporters, including dopamine, norepinephrine, and serotonin transporters (DAT, NET, and SERT, respectively), are important therapeutic targets due to their essential roles in the brain. To overcome the slow action of selective monoamine reuptake inhibitors, dual- or triple-acting inhibitors have been developed. Here, to examine whether combination treatments of selective reuptake inhibitors have synergistic effects, the pharmacological properties of DAT, NET, and SERT were investigated using the selective inhibitors of each transporter, which are vanoxerine, nisoxetine, and fluoxetine, respectively. Potencies were determined via fluorescence-based substrate uptake assays in the absence and presence of other inhibitors to test the multi-drug effects on individual transporters, resulting in antagonistic effects on DAT. In detail, fluoxetine resulted in a 1.6-fold increased IC50 value of vanoxerine for DAT, and nisoxetine produced a more drastic increase in the IC50 value by six folds. Furthermore, the effects of different inhibitors, specifically monovalent ions, were tested on DAT inhibition by vanoxerine. Interestingly, these ions also reduced vanoxerine potency in a similar manner. The homology models of DAT suggested a potential secondary inhibitor binding site that affects inhibition in an allosteric manner. These findings imply that the use of combination therapy with monoamine reuptake inhibitors should be approached cautiously, as antagonistic effects may occur.

Spatial and temporal variations in trophic structure of fish assemblages in the Yellow Sea revealed by C and N stable isotopes.

In this study, we assessed spatial and temporal variations in the trophic structure of fish assemblages in the Yellow Sea during spring and summer 2022 and compared their isotopic niches between the Provisional Measure Zone (PMZ) and Korea's west areas (non-PMZ) within the Yellow Sea. Spatial and temporal differences in the diversity and dominant species of fish assemblages were found between the PMZ and non-PMZ areas between the seasons. The mean δ13C values of fish assemblages were relatively higher in the non-PMZ areas than in the PMZ areas. In contrast, no significant differences were found in the mean δ15N values between the areas. Generally, the isotopic niche indices were relatively narrow in the PMZ areas compared to those in the non-PMZ areas. Overall, these spatial differences between the PMZ and non-PMZ areas suggest different trophic diversity of fish assemblages, resulting from site-specific variations in environmental conditions and community composition.

Standardized image-based polysomnography database and deep learning algorithm for sleep-stage classification.

STUDY OBJECTIVES: Polysomnography (PSG) scoring is labor-intensive, subjective, and often ambiguous. Recently several deep learning (DL) models for automated sleep scoring have been developed, they are tied to a fixed amount of input channels and resolution. In this study, we constructed a standardized image-based PSG dataset in order to overcome the heterogeneity of raw signal data obtained from various PSG devices and various sleep laboratory environments. METHODS: All individually exported European data format files containing raw signals were converted into images with an annotation file, which contained the demographics, diagnoses, and sleep statistics. An image-based DL model for automatic sleep staging was developed, compared with a signal-based model, and validated in an external dataset. RESULTS: We constructed 10253 image-based PSG datasets using a standardized format. Among these, 7745 diagnostic PSG data were used to develop our DL model. The DL model using the image dataset showed similar performance to the signal-based dataset for the same subject. The overall DL accuracy was greater than 80%, even with severe obstructive sleep apnea. Moreover, for the first time, we showed explainable DL in the field of sleep medicine as visualized key inference regions using Eigen-class activation maps. Furthermore, when a DL model for sleep scoring performs external validation, we achieved a relatively good performance. CONCLUSIONS: Our main contribution demonstrates the availability of a standardized image-based dataset, and highlights that changing the data sampling rate or number of sensors may not require retraining, although performance decreases slightly as the number of sensors decreases.

Factors affecting the willingness to pay extra for safe food.

BACKGROUND/OBJECTIVES: With the outbreak of infectious diseases, such as coronavirus disease 2019 (COVID-19), public interest in health and safety has increased, and consequently, interests in food safety have been heightened too. The purpose of this study was to compare and analyze the involvement of various categories of consumers in food safety, the subjective evaluation of food safety in Korea, and the willingness of the consumers to pay extra for safe food according to their demographic and socioeconomic characteristics. MATERIALS/METHODS: This study used data from the 2020 Consumer Behavior Survey for Food provided by the Korea Rural Economic Institute (KREI). The subjects were 6,355 adult household members aged 19 to 75 years old. The survey was conducted from June 10th to August 21st, 2020. The data for the study were subjected to statistical analyses, including descriptive statistics, complex sample general linear model, k-means cluster, and multiple regression analyses. RESULTS: The factors affecting the willingness to pay extra for safe food were education level, occupation, monthly household income, presence of a young (teenager) household member, and the subjects' involvement in food safety. the significant factors affecting the willingness to pay extra for safe food were sex, age, and income level for the group exhibiting a low level of involvement in food safety, while education level and presence of a young household member were the statistically significant factors for the group exhibiting a high level of involvement in food safety. CONCLUSION: This study verified the differences in the factors associated with the willingness to pay extra for safe food according to the demographic and socioeconomic characteristics, involvement in food safety, subjective evaluation of food safety. This study offers practical implications to the industry and government that would help in directing strategies to strengthen safe food management.

Trophic response of fishes to rainfall variability in a temperate estuarine system of Korea: A stable isotope approach.

To assess the basal resources supporting food webs impacted by rainfalls, we compared stable isotope ratios (δ13C and δ15N) of fish consumers and organic matter sources between up- and down-sites in an estuary between seasons (June and September) and years (2018 and 2019) that showed different patterns of summer monsoon. Our study showed seasonal differences in the δ13C and δ15N values of basal resources and fish consumers in both years. At the up-site, significant differences of δ13C values of fish consumers were found between years, resulting from changing rainfall period, thereby causing a shift in food availability from terrigenous organic matter to periphyton. In contrast, at the down-site, the consistent isotopic values of fishes were observed in both years, suggesting that rainfall shift has a negligible impact on resources for fishes. Overall, the annual shift in resources for fishes in the estuary may be controlled by contrasting rainfall events.

Estuarine dam water discharge enhances summertime primary productivity near the southwestern Korean coast.

The gate opening of estuarine dams discharge a large amount of freshwater into coastal zones during the summer monsoon in northeast Asia. We investigated seasonal and spatial variations in primary productivity (PP) and community structures of phytoplankton on a downstream macrotidal flat and examined the dam discharge effects. Our harmonic analysis of the PP revealed a clear seasonality with a unimodal peak in summer, possibly driven by high ammonium loading through internal recycling. External nitrate supply from the dam-water discharge promoted PP during July-August, generating conspicuous blooms near the discharging site. Phytoplankton community was characterized by a predominance of diatoms all year round and seasonal dominances from dinoflagellates, cryptophytes, and prasinophytes in spring to chlorophytes in summer, reflecting spatiotemporal patterns in ammonium and nitrate supply. Our findings provide new insights into the summer phytoplankton bloom linked to monsoonal rainfall in the shallow coastal seas along the Northeast Asian coast.

Exploiting volumetric wave correlation for enhanced depth imaging in scattering medium.

Imaging an object embedded within a scattering medium requires the correction of complex sample-induced wave distortions. Existing approaches have been designed to resolve them by optimizing signal waves recorded in each 2D image. Here, we present a volumetric image reconstruction framework that merges two fundamental degrees of freedom, the wavelength and propagation angles of light waves, based on the object momentum conservation principle. On this basis, we propose methods for exploiting the correlation of signal waves from volumetric images to better cope with multiple scattering. By constructing experimental systems scanning both wavelength and illumination angle of the light source, we demonstrated a 32-fold increase in the use of signal waves compared with that of existing 2D-based approaches and achieved ultrahigh volumetric resolution (lateral resolution: 0.41 [Formula: see text], axial resolution: 0.60 [Formula: see text]) even within complex scattering medium owing to the optimal coherent use of the broad spectral bandwidth (225 nm).

Prediction of efficiencies for diverse prime editing systems in multiple cell types.

Applications of prime editing are often limited due to insufficient efficiencies, and it can require substantial time and resources to determine the most efficient pegRNAs and prime editors (PEs) to generate a desired edit under various experimental conditions. Here, we evaluated prime editing efficiencies for a total of 338,996 pairs of pegRNAs including 3,979 epegRNAs and target sequences in an error-free manner. These datasets enabled a systematic determination of factors affecting prime editing efficiencies. Then, we developed computational models, named DeepPrime and DeepPrime-FT, that can predict prime editing efficiencies for eight prime editing systems in seven cell types for all possible types of editing of up to 3 base pairs. We also extensively profiled the prime editing efficiencies at mismatched targets and developed a computational model predicting editing efficiencies at such targets. These computational models, together with our improved knowledge about prime editing efficiency determinants, will greatly facilitate prime editing applications.

The clinical influence of nasal surgery on PAP compliance and optimal application among OSA subjects uncomfortable with PAP device wear.

This study aimed to evaluate the alteration of PAP compliance after nasal surgery and to determine the optimal indications of nasal surgery in obstructive sleep apnea (OSA) subjects. Among OSA subjects using PAP devices, 29 subjects who underwent septoturbinoplasty due to nasal obstruction were included and their pre- and postoperative medical and PAP records were reviewed retrospectively. Postoperative autoPAP usage data was further assessed by grouping the compliance (the percentage of days with usage ≥ 4 h) data (group 1: the good compliance group; group 2: the poor compliance group). The data showed that 56% of subjects in group 1 complained of nasal obstruction as the only barrier to using a PAP device and about 89% reported experiencing the efficacy of PAP usage. Both the mean and peak average PAP pressures were significantly reduced in group 1 following nasal surgery. Group 2 had multiple subjective problems that interfered with wearing a PAP device and reported a lack of experiencing the efficacy of PAP usage. Preoperative nasal cavity volume values were smaller and absolute blood eosinophil counts were significantly lower in group 1. The current data demonstrate that nasal surgery might increase the compliance of PAP device wear in OSA subjects who complained of only nasal obstruction as a barrier to wearing PAP and who had small nasal cavity volumes combined with allergic inflammation.

Sleep parameter characteristics of patients with OSA who have retropalatal circumferential narrowing and the clinical significance of lateral pharyngeal wall collapse during sleep.

BACKGROUND: The lateral pharyngeal wall (LPW) is a critical anatomic structure in patients with obstructive sleep apnea (OSA). Resolving the retropalatal circumferential (RC) narrowing caused by combination of both LPW collapse and antero-posterior (AP) narrowing holds promise for surgical treatment of OSA. We sought to determine the clinical characteristics and distinctive alterations in sleep parameters of patients with OSA who have RC narrowing and LPW collapse. METHODS: Drug-induced sleep endoscopy (DISE), polysomnography findings, and sleep questionnaires were reviewed retrospectively in patients with OSA. RESULTS: Of the 106 OSA patients examined, 48% showed RC narrowing and 44% showed AP narrowing at the oropharynx level during sleep while 8% of the patients showed only LPW collapse. Patients with RC narrowing with LPW collapse exhibited a higher BMI than those with AP narrowing only. In addition, patients with RC narrowing showed more aggravated sleep parameters including apneic events than patients with AP narrowing alone. The degree of RC narrowing correlated significantly with the severity of OSA as shown by a higher apnea index and lower oxygen desaturations. CONCLUSIONS: Our clinical findings suggest that the presence of RC narrowing with LPW collapse in OSA is closely related to increased apneic and oxygen desaturation events. RC narrowing with LPW collapse may be targets for surgical correction in patients with OSA to improve therapeutic outcomes.

High-Intensity Focused Ultrasound Therapy Versus Coblation for the Treatment of Inferior Turbinate Hypertrophy: A Clinical Trial.

OBJECTIVES: To compare the efficacy and safety of high-intensity focused ultrasound (HIFU) therapy with coblation for the treatment of inferior turbinate hypertrophy (ITH). METHODS: In this randomized controlled clinical trial, 20 patients underwent inferior turbinate surgery, which consisted of either HIFU or coblation therapy. Efficacy, safety, and tolerability were evaluated by subjective symptom scores, acoustic rhinometry, and nasal endoscopy. RESULTS: The modified nasal obstruction symptom evaluation (NOSE) score and nasal obstruction visual analog scale (NO-VAS) significantly decreased in both groups 12 weeks postoperatively. The between-group differences in the evaluation scores were not statistically significant. On nasal endoscopy, the HIFU patients showed improvements in mucosal swelling sooner than the patients undergoing coblation therapy. Nasal crusting significantly increased in the patients undergoing coblation compared to the patients undergoing HIFU therapy until postoperative week 4. Mucosal preservation was superior in the HIFU patients. Although HIFU was less painful than coblation therapy during the procedure, the difference was not significant (4.9 vs. 6.3, P=0.143). The difference in global satisfaction between the two groups was not statistically significant, although satisfaction was slightly higher among the HIFU patients than among the coblation patients (4.6 vs. 4.1, P=0.393). CONCLUSION: HIFU provided results similar to those of coblation therapy for patients with nasal obstruction due to ITH, but HIFU therapy caused less discomfort during the procedure. HIFU therapy appears to be a good noninvasive alternative to the current surgical modalities for ITH.