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1.
Clin Exp Otorhinolaryngol ; 15(1): 5-23, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35158420

RESUMO

The Korean Society of Otorhinolaryngology-Head and Neck Surgery and Korean Rhinologic Society appointed a guideline development group (GDG) to establish a clinical practice guideline, and the GDG developed a guideline for nasal irrigation for adult patients with chronic rhinosinusitis (CRS). The guideline focuses on knowledge gaps, practice variations, and clinical concerns associated with nasal irrigation. Nasal irrigation has been recommended as the first-line treatment for CRS in various guidelines, and its clinical effectiveness has been demonstrated through a number of studies with robust evidence. However, no guidelines have presented a consistent nasal irrigation method. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. The committee developed 11 evidence-based recommendations. This guideline focuses on the evidence-based quality improvement opportunities deemed the most important by the GDG. Moreover, the guideline addresses whether nasal lavage helps treat CRS, what type of rinsing solution should be used, and the effectiveness of using additional medications to increase the therapeutic effect.

2.
Sleep Breath ; 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34741243

RESUMO

PURPOSE: Although polysomnography (PSG) is the gold standard for monitoring sleep, it has many limitations. We aimed to prospectively determine the validity of wearable sleep-tracking devices and smartphone applications by comparing the data to that of PSGs. METHODS: Patients who underwent one night of attended PSG at a single institution from January, 2015 to July 2019 were recruited. Either a sleep application or wearable device was used simultaneously while undergoing PSG. Nine smartphone applications and three wearable devices were assessed. RESULTS: We analyzed the results of 495 cases of smartphone applications and 170 cases of wearables by comparing each against PSG. None of the tested applications were able to show a statistically significant correlation between sleep efficiency, durations of wake time, light sleep or deep sleep with PSG. Snore time correlated well in both of the two applications which provided such information. Deep sleep duration and WASO measured by two of the three wearable devices correlated significantly with PSG. Even after controlling for transition count and moving count, the correlation indices of the wearables did not increase, suggesting that the algorithms used by the wearables were not largely affected by tossing and turning. CONCLUSIONS: Most of the applications tested in this study showed poor validity, while wearable devices mildly correlated with PSG. An effective use for these devices may be as a tool to identify the change seen in an individual's sleep patterns on a day-to-day basis, instead of as a method of detecting absolute measurements.

3.
PLoS One ; 16(2): e0246399, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33529265

RESUMO

Obstructive sleep apnea is a highly prevalent cyclic repetitive hypoxia-normoxia respiratory sleep disorder characterized by intermittent upper-airway collapse. It is mainly diagnosed using in-laboratory polysomnography. However, the time-spatial constraints of this procedure limit its application. To overcome these limitations, there have been studies aiming to develop clinical prediction formulas for screening of obstructive sleep apnea using the risk factors for this disorder. However, the applicability of the formula is restricted by the group specific factors included in it. Therefore, we aimed to assess the risk factors for obstructive sleep apnea and develop clinical prediction formulas, which can be used in different situations, for screening and assessing this disorder. We enrolled 3,432 Asian adult participants with suspected obstructive sleep apnea who had successfully undergone in-laboratory polysomnography. All parameters were evaluated using correlation analysis and logistic regression. Among them, age, sex, hypertension, diabetes mellitus, anthropometric factors, Berlin questionnaire and Epworth Sleepiness Scale scores, and anatomical tonsil and tongue position were significantly associated with obstructive sleep apnea. To develop the clinical formulas for obstructive sleep apnea, the participants were divided into the development (n = 2,516) and validation cohorts (n = 916) based on the sleep laboratory visiting date. We developed and selected 13 formulas and divided them into those with and without physical examination based on the ease of application; subsequently, we selected suitable formulas based on the statistical analysis and clinical applicability (formula including physical exam: sensitivity, 0.776; specificity, 0.757; and AUC, 0.835; formula without physical exam: sensitivity, 0.749; specificity, 0.770; and AUC, 0.839). Analysis of the validation cohort with developed formulas showed that these models and formula had sufficient performance and goodness of fit of model. These tools can effectively utilize medical resources for obstructive sleep apnea screening in various situations.


Assuntos
Apneia Obstrutiva do Sono/epidemiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Prognóstico , Fatores de Risco , Fatores Sexuais , Apneia Obstrutiva do Sono/diagnóstico
4.
Sleep Breath ; 25(3): 1477-1485, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33398794

RESUMO

PURPOSE: Positive airway pressure (PAP) devices have been widely used as the first line of treatment in obstructive sleep apnea (OSA). Most advanced PAP devices support the estimation of respiratory index (RI) using the patient's mask airflow. In addition to the compliance factor for PAP device use, which is important for monitoring patient sleep health, RI is also becoming important for monitoring. However, there are few reports that validate RI of a PAP device with polysomnography. METHODS: Between January 2015 and December 2017, 50 participants were enrolled who were diagnosed with OSA and prescribed auto-titration PAP (APAP) devices. The RIs of participants were measured at night using APAP devices, concurrently with electroencephalography, respiratory inductance plethysmography sensors, and other polysomnographic sensors in a sleep laboratory. The respiratory-related data of APAP were prospectively analyzed with the manually scored polysomnographic data. RESULTS: The apnea-hypopnea index and apnea index showed a statistically close relationship between the auto-scored respiratory data from the APAP device and the manually scored respiratory data from polysomnographic sensors. Obstructive apnea and central apnea indices showed relatively low correlations. The differences between the auto-scored RI and manually scored RI were influenced by BMI, waist circumference, weight, oxygen saturation, and respiratory distress indices of diagnostic polysomnographic factors. CONCLUSIONS: The RIs of APAP devices have a tendency to be underestimated or mismatched when compared with polysomnography. Sleep specialists are advised to consider additional anthropometric and diagnostic factors to account for these differences during PAP treatment.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Respiração , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Reprodutibilidade dos Testes
5.
Sleep Breath ; 25(3): 1453-1460, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33389556

RESUMO

PURPOSE: Intermittent hypoxia (IH) is characterized by hypoxia-reoxygenation, reported to be a critical risk factor for obstructive sleep apnea (OSA). This experiment aimed to evaluate the direct effects of IH on the human nasal mucosa. METHODS: The direct effects of IH on the human nasal mucosa was evaluated by measuring the ciliary beat frequency (CBF) and expression levels of inflammatory cytokines (granulocyte-macrophage colony-stimulating factor, transforming growth factor-ß, interleukin-6, and tumor necrosis factor-α). The normoxia group was exposed to a normoxic condition for 72 h. The IH group was exposed to 288 cycles of IH (1 cycle: hypoxia, 5 min; subsequent normoxia, 10 min) for 72 h. CBF was measured using an automated computer-based video image processing technique. Changes in the expression of cytokines were assessed by real-time reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: The normoxia group revealed a persistent CBF pattern and a physiological range of inflammatory cytokines. However, the IH group showed a cyclic decrease in CBF and increased expression of inflammatory cytokines. Cytotoxicity assay indicated no difference in the survival rates between the two groups. CONCLUSIONS: IH results in increased expression of inflammatory cytokines that adversely affects the mucociliary transport in the upper airway and, consequently, may result in airway inflammation.


Assuntos
Hipóxia/fisiopatologia , Mucosa Nasal/metabolismo , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
J Clin Monit Comput ; 35(4): 779-785, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-32472337

RESUMO

Among various methods for measuring the plasma volume (PV), the indocyanine green (ICG) dilution technique is a relatively less invasive method. However, the ICG method is rather cumbersome because 10 blood samples need to be obtained within a short time after ICG administration. Thus, reducing the frequency of blood sampling while maintaining the accuracy would facilitate plasma volume measurement in clinical situations. We here developed a modified method to measure plasma volume using 2260 ICG plasma concentration data from 115 surgical patients. The mean relative error (MRE) and the percentage of cases with relative error (RE) greater than 5% in total (PRE) were used to quantify the difference between plasma volumes obtained by the original and modified methods. RE was determined as follows. RE(%) = (PV obtained by original method (PVoriginal)-PV obtained by modified method (PVmodified))/PVoriginal × 100. PVmodified was assumed to be equal to PVoriginal when the RE was < 5%. When the number of samples selected for the plasma volume estimation was 4 or less, the PRE was mostly 10% or more. Five out of the 10 blood samples (order: 1st, 2nd, 3rd, 9th, and 10th) showed similar accuracies with the plasma volume obtained by the original method (original: 2.72 ± 0.64 l, modified: 2.72 ± 0.65 l). This modified method may be able to aptly replace the original method and lead to a wider clinical application of the ICG dilution technique. Further validation is needed to determine if the results of this study may be applied in other populations.


Assuntos
Verde de Indocianina , Volume Plasmático , Coleta de Amostras Sanguíneas , Volume Sanguíneo , Corantes , Humanos , Técnicas de Diluição do Indicador
7.
Sci Rep ; 10(1): 4168, 2020 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-32144371

RESUMO

Normal-range sleep duration is an important factor for general health and metabolism, and insufficient or excessive sleep is associated with chronic metabolic disease. Among the many factors that affect sleep duration, sun exposure plays an important role in maintaining regular circadian rhythm and is also involved in the production and activation of 25-hydroxyvitamin D [25(OH)D], which regulates various functions in the body. However, 25(OH)D is available through food and various nutritional supplements without sun exposure, so it is important to find out the complex relationship among sun exposure, vitamin D status, and sleep duration. The relationship between sun exposure, vitamin D status, and sleep duration was analyzed in the nationwide survey and examination of 25,534 study populations, after adjusting for demographic characteristics, physical characteristics, lifestyle status, and socio-demographic variables. Vitamin D status alone did not show the relationship with sleep duration, although there were statistical relationships in the various factors including sun exposure with sleep duration. There was a statistical difference in 25(OH)D according to sleep duration, only in low sun exposure group. Subjects with low sun exposure and excessive sleep duration comparatively lower 25(OH)D than those with normal-range sleep, even after adjustment for potentially confounding factors. Individuals with limited exposure to sunlight should maintain adequate vitamin D status to have an appropriate sleep duration for health.


Assuntos
Sono/fisiologia , Luz Solar , Vitamina D/análogos & derivados , Adulto , Idoso , Animais , Estudos Transversais , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/fisiopatologia , Adulto Jovem
8.
Sleep Breath ; 24(1): 127-134, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31667682

RESUMO

PURPOSE: Respiratory inductive plethysmography (RIP) is recommended as an alternative respiratory sensor for the identification of each apnea and hypopnea event in polysomnography. Using this sensor, the cumulative RIP results from the chest and abdomen (RIP sum) and time-derived results of the RIP sum (RIP flow) are calculated to track respiratory flow. However, the effectiveness of this sensor and the calculated respiratory results is still unclear, and validation studies for the scoring of respiratory events in polysomnography are rare. METHODS: Two hundred subjects were selected according to the severity of obstructive sleep apnea. A sleep specialist re-evaluated the respiratory events based on RIP flow data in a single-blind study. Statistical analysis was conducted with paired respiratory events scored in each of the RIP flow and polysomnography datasets. RESULTS: All respiratory events scored from the RIP flow were strongly correlated with those identified with standard sensors of polysomnography, regardless of disease severity. Most of the respiratory parameters from RIP flow trended toward underestimation. The RIP flow obtained from the alternative RIP sensor was appropriate for the diagnosis of obstructive sleep apnea based on a receiver operating characteristic curve. CONCLUSIONS: Scored respiratory events from RIP flow data effectively reflected the respiratory flow and statistically correlated with the results from standard polysomnography sensors. Therefore, analyzing RIP flow utilizing an RIP sensor is considered a reliable method for respiratory event scoring.


Assuntos
Pletismografia de Impedância/instrumentação , Polissonografia/métodos , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Idoso , Cardiografia de Impedância/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Apneia Obstrutiva do Sono/fisiopatologia
9.
PLoS One ; 13(10): e0206328, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30352085

RESUMO

Olfactory dysfunction and tinnitus are age-related otorhinolaryngological disorders with a high prevalence in the elderly population and share several common clinical features. However, there is no study investigating the relationship between these two diseases. We studied the prevalence of olfactory dysfunction and tinnitus among Koreans and studied the relationship between these two diseases based on the Korean National Health and Nutrition Examination Survey. The subjects of this study were enrolled from the Fifth Korean National Health and Nutrition Examination Survey (2010-2012, n = 25,534). Data of subjects aged 40 years and older who underwent physical examination and completed a self-reported questionnaire and other anthropometric variables were statistically analyzed. Odds ratios were calculated to identify the relationship between olfactory dysfunction and tinnitus, using multiple logistic regression models. Older males, non-smokers, non/lower alcohol drinker groups exhibited the relationship between olfactory dysfunction and tinnitus. Metabolic syndrome and mental health problems were associated with both olfactory dysfunction and tinnitus. After adjusting for confounding factors, olfactory dysfunction was significantly associated with tinnitus (OR 1.318). There was a dose-response relationship between tinnitus severity and the odds of olfactory dysfunction (ORs for mild, moderate and severe tinnitus were, respectively, 1.134, 1.569 and 2.044). Additional molecular genetics and animal studies are needed to determine the shared pathophysiology of the two diseases.


Assuntos
Transtornos do Olfato/epidemiologia , Zumbido/epidemiologia , Consumo de Bebidas Alcoólicas , Feminino , Humanos , Masculino , Saúde Mental , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Inquéritos Nutricionais , Razão de Chances , Transtornos do Olfato/complicações , Transtornos do Olfato/patologia , Prevalência , República da Coreia/epidemiologia , Índice de Gravidade de Doença , Fumar , Inquéritos e Questionários , Zumbido/complicações , Zumbido/patologia
10.
Eur Arch Otorhinolaryngol ; 275(5): 1189-1196, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29564540

RESUMO

PURPOSE: Considerable number of patients with obstructive sleep apnea (OSA) failed to respond to positive airway pressure therapy and so turned to surgical procedures. A wide variety of surgical procedures have been developed and advanced, according to obstruction and target site through nasal cavity to trachea. We introduced our overlapping lateral pharyngoplasty (OLP) technique as a surgical option for OSA and evaluated its surgical outcomes both with and without endoscope-guided coblator tongue base resection (CobTBR). METHODS: Sixty-five patients underwent either OLP alone or OLP combined with CobTBR to treat OSA at academic tertiary center. Twenty-nine patients underwent postoperative polysomnography and were divided into two groups, as an OLP group and an OLP combined CobTBR group. Various parameters from physical examinations and polysomnographic results were compared and analyzed. RESULTS: Most enrolled patients improved on various polysomnographic parameters, including AHI and oxygen levels. In the OLP group, 91.7% of patients showed a surgical response and the overall success rate was 66.7%. Mean AHI improved significantly from 36.3 to 14.8. In the OLP + CobTBR group, all patients showed improvement in AHI and the surgical response rate was 100%. The overall success rate was 70.6% and mean AHI improved from 38.8 to 13.1. In both groups, various parameters such as RDI, lowest O2 saturation, mean O2 saturation, oxygen desaturation index, supine AHI, and ESS significantly improved after surgery. CONCLUSION: Our OLP technique appears to be safe and effective among OSA patients. Multi-level OLP surgery combined with CobTBR can be a good surgical strategy for patients experiencing retroglossal obstruction.


Assuntos
Glossectomia/métodos , Faringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Língua/cirurgia , Adulto , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Resultado do Tratamento
11.
Int J Pediatr Otorhinolaryngol ; 106: 41-45, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29447889

RESUMO

OBJECTIVES: Pediatric obstructive sleep apnea has a relatively high prevalence and has various negative health and behavioral consequences. Among the various complications of pediatric obstructive sleep apnea, growth disturbance is still controversial. METHOD: 745 pediatric subjects with obstructive sleep apnea diagnosed by in-lab polysomnography were enrolled, after excluding ineligible subjects with abnormal growth related factors. Height, weight, and BMI of enrolled patients were measured and statistically converted to z-scores, and the converted data were analyzed statistically with the polysomnographic results. Multiple linear regression were used to analyze the relationships between age, gender, z-score for weight, polysomnography results, and z-score for height. RESULTS: Patients with higher respiratory related index or lower mean/lowest oxygen saturation of PSG showed smaller z-score for height. Mean apnea hypopnea index and standard deviation of enrolled patients was 7.46 ±â€¯12.92, with moderate severity. And mean z-score for height and standard deviation was 0.21 ±â€¯1.15. Apnea hypopnea index, respiratory disturbance index, obstructive apnea index, and hypopnea index, respiratory related results of polysomnography, were statistically negative correlated with a z-score for height. And mean oxygen saturation and lowest oxygen saturation, oxygen saturation results of polysomnography, were statistically positive correlated with a z-score for height. CONCLUSIONS: Respiratory related results and oxygen saturation results of polysomnography show negative and positive correlation with z-score for height. Therefore, pediatric obstructive sleep apnea have a negative effect on longitudinal growth.


Assuntos
Desenvolvimento Infantil , Transtornos do Crescimento/etiologia , Apneia Obstrutiva do Sono/complicações , Antropometria , Criança , Feminino , Humanos , Masculino , Polissonografia/métodos , Análise de Regressão , Estudos Retrospectivos
12.
Mediators Inflamm ; 2017: 4327237, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29038619

RESUMO

PURPOSE: We hypothesized that CIH may affect the upper airway immune system and aimed to verify whether CIH can induce airway inflammation in a murine obstructive sleep apnea (OSA) model. METHODS: C57BL6 male mice were exposed to intermittent hypoxia (CIH group; 5 ~ 21% FiO2, 120 sec cycles, 12 h/d, n = 6) or room air (Sham group, n = 6) for up to 4 weeks in identical chambers. Nasal and lung tissues and lavage fluid were collected and analyzed by multiplex assay. Lung lavage fluid was also utilized for FACS analysis to determine eosinophil count. RESULTS: We determined the protein level of 24 different cytokines, chemokines, and inflammatory mediators. Among various cytokines, levels of IL-1α, IL-1ß, IL-4, IL-6, and IL-13 were significantly elevated in nose or lung tissue from the CIH group. In addition, MCP-1 and periostin were elevated in nose and lung tissue and lavage fluid from the CIH group. CONCLUSIONS: CIH for 4 weeks altered the levels of inflammatory mediators in both the nose and lungs of mouse model. We suggest that the airway immune system may be deteriorated by CIH and allergic inflammation in the upper or lower airway could be worsened by sleep apnea.


Assuntos
Quimiocinas/metabolismo , Citocinas/metabolismo , Hipóxia/metabolismo , Animais , Interleucina-13/metabolismo , Interleucina-1alfa/metabolismo , Interleucina-1beta/metabolismo , Interleucina-4/metabolismo , Interleucina-6/metabolismo , Pulmão/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Boca/metabolismo
13.
Infect Chemother ; 49(4): 326-352, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29299900

RESUMO

These guidelines were developed as part of the 2016 Policy Research Servicing Project by the Korea Centers for Disease Control and Prevention. A multidisciplinary approach was taken to formulate this guideline to provide practical information about the diagnosis and treatment of adults with acute upper respiratory tract infection, with the ultimate aim to promote the appropriate use of antibiotics. The formulation of this guideline was based on a systematic literature review and analysis of the latest research findings to facilitate evidence-based practice, and focused on key questions to help clinicians obtain solutions to clinical questions that may arise during the care of a patient. These guidelines mainly cover the subjects on the assessment of antibiotic indications and appropriate selection of antibiotics for adult patients with acute pharyngotonsillitis or acute sinusitis.

14.
J Craniofac Surg ; 27(3): e248-9, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27100635

RESUMO

Chronic rhinosinusitis is one of the most common inflammatory diseases with a significant impact on the affected patients. Orbital complications, one of the emergent complications of chronic rhinosinusitis, can be occurred in frontal sinusitis. For early diagnosis and therapy of orbital complications, proper evaluation is essential to prevent loss of vision.Recently, the authors diagnose and treat completely a 60-year-old man with isolated unilateral superior branch palsy of the oculomotor nerve caused by frontal sinusitis. Four days after draining the frontal sinusitis, the patient recovered fully from superior branch palsy of the oculomotor nerve. Frontal sinusitis can cause isolated superior branch palsy of the oculomotor nerve in patients with a history of facial trauma.


Assuntos
Sinusite Frontal/complicações , Doenças do Nervo Oculomotor/etiologia , Nervo Oculomotor/diagnóstico por imagem , Doença Crônica , Endoscopia , Sinusite Frontal/diagnóstico , Sinusite Frontal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/diagnóstico , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Tomografia Computadorizada por Raios X
15.
Allergy Asthma Immunol Res ; 8(1): 69-78, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26540504

RESUMO

PURPOSE: Although differentiated normal human nasal epithelial (NHNE) cells can be used to study the role of human nasal epithelium, there is a need for effective culture models of nasal epithelium in sinonasal disease status, including allergic rhinitis (AR). We aimed to examine the feasibility of intranasal brushing for culture of nasal epithelial cells in AR patients and to verify the hypothesis that allergic nasal epithelial (ARNE) cells differ in histologic and physiologic characteristics. METHODS: We established a system for isolating (via intranasal brushing) and culturing (with air-liquid interface, ALI) nasal epithelial cells from healthy volunteers (n=8) and AR patients (n=8). We used this system to compare the histologic findings and physiologic characteristics of NHNE and ARNE. RESULTS: The histology results showed that fully differentiated ALI culture was obtained at least 14 days after confluence and that both ciliated and secretory cells were well differentiated in ALI culture using nasal brushing. The histology results of ARNE culture were significantly different from NHNE. The number of ciliated cells was lower, and secretory cells were more dominant in ARNE cell culture compared to NHNE cells. We also observed, by electron microscopy, loose tight junctions and short cilia in cultured ARNE cells. In addition, the mRNA level of TSLP which was one of the epithelial-derived allergic cytokines was significantly higher, and the expressions of genes involved in ciliogenesis were lower in cultured ARNE cells without allergen stimulation. CONCLUSIONS: Our findings suggest that ALI culture of ARNE cells using intranasal brushing may be an alternative method for epithelial cell culture in AR patients and that cultured ARNE cells will be useful for in vitro studies of the mechanisms at play during AR because they maintain unique allergic characteristics.

16.
Head Neck ; 38(4): 635-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26560073

RESUMO

BACKGROUND: Multilevel obstruction in obstructive sleep apnea commonly includes retroglossal obstruction. To improve surgical success rates, tongue volume reduction with posterior midline glossectomy and/or lingual tonsillectomy is widely performed. METHODS: Nasotracheal intubation was utilized, and the combined tongue procedure was performed as a final step after palatal surgery. The tongue was pulled maximally by a retraction suture and a McIVOR (Karl Storz, Tuttlingen, Germany) or Davis mouth gag (Karl Storz,Tuttlingen, Germany), and a medium-length tongue blade was applied to expose the tongue base. A 70-degree rigid endoscope was fixed by the holding system and introduced into the oral cavity. Endoscope-guided coblator tongue base resection was then performed. RESULTS: The surgeon could use both hands for the surgery, enabling a more delicate resection of tongue base tissue. CONCLUSION: This technique was acceptable and can be successfully used in patients with a large tongue, in whom exposing the tongue base for surgery is difficult.


Assuntos
Endoscopia/métodos , Glossectomia/métodos , Apneia Obstrutiva do Sono/cirurgia , Língua/cirurgia , Tonsilectomia/métodos , Endoscópios , Humanos , Estudos Retrospectivos
17.
Basic Clin Pharmacol Toxicol ; 118(4): 313-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26440415

RESUMO

This study was aimed to evaluate the efficiency of a new mesh-type nebulizer for the intrapulmonary delivery of ipratropium bromide in surgical patients under mechanical ventilation. A total of 20 patients were randomly allocated to receive 0.5 mg ipratropium bromide using either a control (Pariboy SX, Pari, Co., Starnberg, Germany, n = 10) or test (NE-SM1 NEPLUS, KTMED INC., Seoul, Korea, n = 10) nebulizer during general anaesthesia. Ipratropium bromide was nebulized continuously for 20 min. in each group. Plasma concentrations of ipratropium bromide were obtained from blood samples at preset intervals. Non-compartmental analysis of ipratropium bromide was performed to compare the efficiency of pulmonary drug delivery in both nebulizers. Population pharmacokinetic analysis of ipratropium bromide was performed. Additionally, the noise level during the nebulizer operation and the aerosol particle size for each device were measured. The dose-normalized AUC(last) was 0.10 min/L for both nebulizers. The pharmacokinetics of nebulized ipratropium bromide can be described best by a one-compartment model with first-order absorption. The apparent volume of distribution and metabolic clearance were 1340 L and 6.78 L/min, respectively. Type of nebulizer was a significant covariate for absorption rate constant. The equivalent sound level and median aerosol particle diameter were 35.0 dB and 4.52 µm for the test nebulizer, and 60.2 dB and 3.85 µm for the control nebulizer, respectively. From the standpoint of the dose-normalized AUC(last) , a new vibrating mesh-type nebulizer shows similar performance in the intrapulmonary delivery of ipratropium bromide to that of a jet-type nebulizer in surgical patients.


Assuntos
Broncodilatadores/administração & dosagem , Sistemas de Liberação de Medicamentos/instrumentação , Procedimentos Cirúrgicos Eletivos , Ipratrópio/administração & dosagem , Pulmão/metabolismo , Nebulizadores e Vaporizadores , Administração por Inalação , Aerossóis , Anestesia Geral , Broncodilatadores/sangue , Broncodilatadores/farmacocinética , Humanos , Ipratrópio/sangue , Ipratrópio/farmacocinética , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Tamanho da Partícula , Projetos Piloto , Respiração Artificial , Absorção pelo Trato Respiratório
18.
Laryngoscope ; 126(4): 791-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26372416

RESUMO

OBJECTIVES/HYPOTHESIS: We aimed to evaluate the effectiveness of low-concentration hypochlorous acid (HOCl) nasal irrigation compared to isotonic normal saline for pediatric chronic rhinosinusitis. STUDY DESIGN: This was a randomized, prospective, active-controlled study. METHODS: This study investigated the effectiveness of 4 weeks of low-concentration hypochlorous irrigation by analyzing five categorized subjective symptoms and x-ray findings in pediatric patients with rhinosinusitis. Thirty-seven patients were enrolled, and 26 patients successfully completed the study. RESULTS: Total symptom scores significantly improved with both HOCl and normal saline nasal irrigation, but there was no difference between the two groups. X-ray scores also improved in both groups; improvement was much greater in the HOCl group than the placebo group. CONCLUSIONS: Nasal irrigation with HOCl is an effective adjuvant treatment compared to isotonic normal saline for pediatric sinusitis. LEVEL OF EVIDENCE: 1b.


Assuntos
Ácido Hipocloroso/administração & dosagem , Lavagem Nasal , Sinusite/terapia , Criança , Doença Crônica , Humanos , Estudos Prospectivos , Resultado do Tratamento
19.
Am J Rhinol Allergy ; 29(6): e160-3, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26637562

RESUMO

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.


Assuntos
Alérgenos/imunologia , Índice de Massa Corporal , Histamina/administração & dosagem , Obesidade/complicações , Rinite Alérgica/imunologia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , República da Coreia/epidemiologia , Estudos Retrospectivos , Rinite Alérgica/complicações , Rinite Alérgica/epidemiologia , Testes Cutâneos , Adulto Jovem
20.
BMJ Open ; 5(12): e009541, 2015 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-26674502

RESUMO

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.


Assuntos
Pólipos Nasais/diagnóstico , Rinite/diagnóstico , Sinusite/diagnóstico , Adulto , Idoso , Doença Crônica , Estudos Transversais , Endoscopia , Estudos Epidemiológicos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inquéritos Nutricionais , Atenção Primária à Saúde , República da Coreia , Índice de Gravidade de Doença , Inquéritos e Questionários
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