Chronic intermittent hypoxia impacts the olfactory nervous system in an age-dependent manner: pilot study.

PURPOSE: Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse during sleep, which induces chronic intermittent hypoxia (CIH). CIH results in low-grade inflammation, sympathetic overactivity, and oxidative stress. Nevertheless, it remains unclear how exposure to CIH affects olfaction. The purpose of this study was, therefore, to investigate the cytotoxic effects of CIH exposure on mouse olfactory epithelium and the underlying pathophysiology involved. METHODS: Mice were randomly divided into four groups: Youth mouse (You) + room air (RA), You + intermittent hypoxia (IH), Elderly mouse (Eld) + RA, and Eld + IH (n = 6 mice/group). Mice in the two hypoxia groups were exposed to CIH. The control condition involved exposure to room air (RA) for 4 weeks. Olfactory neuroepithelium was harvested for histologic examination, gene ontology analysis, quantitative real-time polymerase chain reaction (qRT-PCR), and western blotting. RESULTS: Based on qRT-PCR analysis, olfactory marker protein (OMP), Olfr1507, ADCY3, and GNAL mRNA levels were lower, whereas NGFR, CNPase, NGFRAP1, NeuN, and MAP-2 mRNA levels were higher in the You + IH group than in the You + RA group. Olfactory receptor-regulated genes, neurogenesis-related genes and immunohistochemical results were altered in nasal neuroepithelium under CIH exposure. CONCLUSIONS: Based on genetic and cytologic analysis, CIH impacted the olfactory neuroepithelium in an age-dependent manner. Our findings suggest that CIH-induced damage to the olfactory neuroepithelium may induce more severe change in the youth than in the elderly.

3D-structural change of nasopharynx following adenoidectomy: 10-year serial data in a single hospital.

PURPOSE: Scar contracture commonly refers to decreased function in the scar area, whereas scar contraction refers to shortening of the scar length compared to the original wound. Wound scar remodeling occurs during months to years of wound healing to form a mature scar. Serial reports about patients who had undergone adenoidectomy are rare. Thus, the objective of this study was to evaluate some parameters of air way passage in patients who had undergone post adenoidectomy. METHODS: Data of patients who have undergone adenoidectomy between 2000 and 2002 in our hospital were obtained. A total of 154 head and neck CT scans from an adenoidectomy group and a control group were analyzed. We measured lengths of several areas, including the width of posterior wall of nasopharynx, the widest diameter in the upper air way, the length between both Eustachian tubes, the length between both pharyngeal recesses, and the anterior to posterior diameter of the nasopharynx. This study was approved by Institutional Review Board (IRB) of the Department of Otolaryngology Head and Neck Surgery of Catholic University (approval number: UC18RESI0130). RESULTS: There were significant differences in the following parameters between the two groups: the width of posterior wall of nasopharynx and the length between both pharyngeal recesses. CONCLUSION: Extensive removal of soft tissue or injured muscle layer during surgery might be one of the reasons for the narrowing of airway. Keeping in mind not to make much injury the soft tissue or muscles during adenoidectomy is very important for the long-term outcome of this surgery.

In vivo Oxygen Condition of Human Nasal Inferior Turbinate-Derived Stem Cells in Human Nose.

BACKGROUND AND OBJECTIVE: Human nasal inferior turbinate-derived stem cells (hNTSCs) have been considered as a potent and useful source for regenerative medicine. To most effectively mimic the native environment of inferior turbinate could be very effective to hNTSCs biology. Thus, the purpose of this study was to evaluate partial pressure of oxygen (ppO2) and temperature in inferior turbinate. METHODS: Ten patients were enrolled who underwent endoscopic endonasal transsphenoidal skull base tumor surgery between January 2014 and December 2015. The commercially available OxyLab pO2 monitor gauges the ppO2 and temperature using a fluorescence quenching technique. Also, hNTSCs were isolated from 10 patients and cultivated under hypercapnic condition (5, 10, and 15%) to mimic hypoxic intranasal conditions. RESULTS: The measured oxygen concentration in submucosa tissue was higher than that at the surface of the inferior turbinate and the temperature in submucosa tissue was higher than the value at the surface of inferior turbinate. The patterns of proliferation were significantly different according to hypercapnic cultivation conditions and there were statistically significant decreased proliferation rates after the exposure of higher CO2 over a period of 5 days. CONCLUSIONS: Intranasal turbinate tissue showed the hypoxia state in concordance with the result of the other tissues or organs. However, indirectly induced hypoxia influenced the influence on the hNTSCs proliferation negatively. Further study is needed to mimic the real hypoxic state, but our results could be used to optimize the culture environment of hNTSCs, thereby producing the stem cells for regenerative therapies.

Modification of Septal Window to Improve Angled Endoscopic View for Beyond Maxillary Sinus.

Many endoscopic surgeons have showed various techniques on septal window using endoscopic tools. However, each technique has its own merits and faults. In this study, the authors introduce simple and time saving endoscopic window technique by avoiding intranasal suture resulting from simple incision line. The procedure to make septal window is to improve an angled endoscopic view for beyond lateral wall of maxillary sinus with septum preservation. To date, this approach has shown no major or concerning complications and has also showed favorable disease control outcomes while maintaining nasal airway patency and functionality through our experience.

Characteristics of Atypical Orbital Complications of Sinusitis.

INTRODUCTION: Orbital complications of rhinosinusitis in adults are scarcely discussed in the literature. We defined atypical orbital complications as those without typical orbital invasion and not classified by the Chandler classification. These complications present as visual loss of diplopia without soft tissue swelling, pain, or computed tomography images of an orbital abscess. OBJECTIVES: The objective of this study was to review our experience with the management of atypical orbital complications of rhinosinusitis and to identify key factors in the characteristics of these patients. METHODS: A retrospective case series review was conducted from 2015 to 2019 in a tertiary referral center, which included all patients with rhinosinusitis and orbital complications. RESULTS: Five patients were identified with atypical complications in the orbital area. Two of the 5 patients exhibited vision loss without any other symptoms. Two patients showed diplopia with or without ptosis. One patient had a headache and ptosis. Complete recovery was noted in 4 of the 5 patients after endoscopic sinus surgery. CONCLUSION: With future studies, new surgical criteria, including retinal destruction, location of the sinusitis, the onset of ophthalmological symptoms, and culture results may be added to the classical surgical criteria to manage orbital complications of paranasal sinus infection cases.

Structural and functional analysis of a dimeric fumarylacetoacetate hydrolase (EaFAH) from psychrophilic Exiguobacterium antarcticum.

Fumarylacetoacetate hydrolase (FAH) is essential for the degradation of aromatic amino acids as well as for the cleavage of carbon-carbon bonds in metabolites or small organic compounds. Here, the X-ray crystal structure of EaFAH, a dimeric fumarylacetoacetate hydrolase from Exiguobacterium antarcticum, was determined, and its functional properties were investigated using biochemical methods. EaFAH adopts a mixed ß-sandwich roll fold with a highly flexible lid region (Val73-Leu94), and an Mg2+ ion is bound at the active site by coordinating to the three carboxylate oxygen atoms of Glu124, Glu126, and Asp155. The hydrolytic activity of EaFAH toward various substrates, including linalyl acetate was investigated using native polyacrylamide gel electrophoresis, activity staining, gel filtration, circular dichroism spectroscopy, fluorescence, and enzyme assays.

Characterization and mutation anaylsis of a cold-active bacterial hormone-sensitive lipase from Salinisphaera sp. P7-4.

In mammals, hormone sensitive lipase (EC 3.1.1.79, HSL) catalyzes the hydrolysis of triacylglycerols as well as the modifications of a broad range of hydrophobic substrates containing ester linkages. HSLs are composed of an N-terminal ligand-binding domain and a C-terminal catalytic domain. Bacterial hormone-sensitive lipases (bHSLs), which are homologous to the C-terminal domain of mammalian HSLs, have a catalytic triad composed of Ser, His, and Asp. Here, a novel cold-active hormone-sensitive lipase (SaHSL) from Salinisphaera sp. P7-4 was identified, functionally characterized, and subjected to site-directed mutations. The enzymatic properties of SaHSL were investigated using several biochemical and biophysical methods. Interestingly, SaHSL exhibited the ability to act on a broad range of substrates including glyceryl tributyrate and glucose pentaacetate. Homology modeling and site-directed mutagenesis indicated that hydrophobic residues (Leu156, Phe164, and Val204) around the substrate-binding pocket were involved in substrate recognition. In addition, highly conserved amino acids (Glu201, Arg207, Leu208, and Asp227) in the regulatory regions were found to be responsible for substrate specificity, thermostability, and enantioselectivity. In summary, this work provides new insights into the understanding of the C-terminal domain of HSL family and evidence that SaHSL can be used in a wide range of industrial applications.

Is there an association between vitamin D deficiency and adenotonsillar hypertrophy in children with sleep-disordered breathing?

BACKGROUND: Low vitamin D levels have been linked to the risk of sleep-disordered breathing (SDB) in children. Although adenotonsillar hypertrophy (ATH) is the major contributor to childhood SDB, the relationship between ATH and serum vitamin D is uncertain. We therefore investigated the relationship between vitamin D levels and associated factors in children with ATH. METHODS: We reviewed data from all children with SDB symptoms who were treated from December 2013 to February 2014. Of these, 88 children whose serum vitamin D levels were measured were enrolled in the study. We divided the children into four groups based on adenoidal and/or tonsillar hypertrophy. We conducted a retrospective chart review to analyze demographic data, the sizes of tonsils and adenoids, serum 25-hydroxy-vitamin D [25(OH)D] level, body mass index (BMI), and allergen sensitization patterns. RESULTS: Children in the ATH group had a lower mean 25(OH)D level than did those in the control group (p < 0.05). Children with vitamin D deficiencies exhibited markedly higher frequencies of adenoidal and/or tonsillar hypertrophy than did those with sufficient vitamin D (p < 0.05). Spearman's correlation analysis identified an inverse correlation between serum 25(OH)D levels and age, tonsil and adenoid size, and height (all p < 0.05). In a multiple regression analysis, tonsil and adenoid size as well as BMI-z score, were associated with 25(OH)D levels after controlling for age, sex, height, and mite sensitization (p < 0.05). CONCLUSIONS: Our results suggest that low vitamin D levels are linked to ATH. Both the sizes of the adenoids and tonsils and the BMI-z score were associated with the 25(OH)D level. Therefore, measurement of the serum 25(OH)D level should be considered in children with ATH and SDB symptoms.

Intranasal azelastine and mometasone exhibit a synergistic effect on a murine model of allergic rhinitis.

PURPOSE: The purpose of this study was to compare the anti-allergic effects of the combination of azelastine and mometasone with those of either agent alone in a Dermatophagoides farinae (Derf)-induced murine model of allergic rhinitis (AR). MATERIALS AND METHODS: Forty BALB/c mice were divided into five groups: azelastine (A), mometasone (M), a combination of azelastine and mometasone (MA), Derf, and control. Derf served as the allergen. Allergic symptom scores, eosinophil counts, and serum Derf-specific IgE levels were measured. The mucosal levels of mRNAs encoding interferon (IFN)-γ, T-bet, interleukin (IL)-4, GATA-3, Foxp3, IL-17, and ROR-γt were determined by real-time polymerase chain reaction. The T-bet, GATA-3, Foxp3, and ROR-γt results were confirmed by Western blotting. RESULTS: Nose-rubbing motions; the levels of mRNAs encoding IL-4, GATA-3, and ROR-γt; and tissue eosinophil count were reduced in the MA compared with those in the Derf group (all P values <0.05). The levels of mRNAs encoding GATA3 and IL-4 mRNA [synthesized by T helper (Th)2 cells] were reduced and that of mRNA encoding Foxp3 was increased in the MA compared with those in the Derf and A groups. Western blotting confirmed these findings. CONCLUSION: We found that the combination of intranasal azelastine and mometasone synergistically suppressed Th17 responses and (reciprocally) elevated Treg responses. Therefore, this combination not only ameliorated allergic inflammation by suppressing Th2 responses, but also usefully modified the Treg/Th17 balance.

Transnasal Endoscopic Resection of a Pleomorphic Adenoma Originate From Nasal Floor.

A 81-year-old female presented to our hospital frequent epistaxis. Nasal endoscopy showed a mass obstructing nasal cavity completely and occupying middle meatus. Magnetic resonance imaging was performed, an about 4.8 × 4 × 4.2 cm sized heterogeneous T2 high signal intensity and T1 enhancing mass mainly involving right nasal cavity with invasion of right hard palate with bony destruction. Therefore, the authors planned to do endoscopic mass excision, under general anesthesia for diagnosis and treatment. The authors removed the mass from lateral nasal wall, nasal roof, nasal septum, medial maxillary wall by piece-meal. Margins of mass were clear except the nasal floor. So, the authors did frozen biopsy to confirm the clear margin in nasal floor. Endoscopy enables better visualization of tumor margins, facilitating complete removal and avoiding excessive resection and following up using good visualization.