Prevention of Incident Hypertension in Patients With Obstructive Sleep Apnea Treated With Uvulopalatopharyngoplasty or Continuous Positive Airway Pressure: A Cohort Study

Purpose

To determine whether treatment with uvulopalatopharyngoplasty (UPPP) or continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) prevents hypertension, compared to those not receiving any treatment.

Methods

A retrospective cohort study was conducted among 413 patients with OSA (age ≥ 35 years) at the Shuang Ho Hospital between 2009 and 2016. The patients were divided into three groups: UPPP, CPAP, and non-treatment groups. Data about the personal characteristics, history of comorbidities, and polysomnography (PSG) reports were collected at baseline. A Cox model with inverse probability of treatment weighting was used to adjust for confounders and baseline diversity.

Results

After multivariate adjustment and weighting for incident hypertension, patients in both the CPAP and UPPP groups showed a significant preventive effect on hypertension than in the non-treatment group. Moreover, patients in the CPAP group had lower event rates than those in the UPPP group.

Conclusion

UPPP can prevent the development of new-onset hypertension in patients with OSA. CPAP had a better preventive effect than UPPP. UPPP might be a good alternative for reducing the risk of the onset of hypertension when compliance to CPAP is poor.

Iatrogenic Vocal Fold Paralysis: A Population-Based Cohort Study in Taiwan

OBJECTIVE

Iatrogenic vocal fold paralysis is an important issue in laryngology, yet there are few population-based studies regarding the epidemiology. This study used a nationwide population-based claims database (the National Health Insurance Research Database) to investigate the epidemiology of iatrogenic unilateral and bilateral vocal fold paralysis (UVFP/BVFP) among the general adult population in Taiwan.

METHOD

This study analyzed patients (20-90 years old) who underwent thyroid, parathyroid, thoracic, cardiac, or anterior cervical spine operations with vocal fold paralysis among adults in Taiwan from January 1, 2007 to December 31, 2013. The codes for vocal fold paralysis were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Claims data in the Taiwan National Health Insurance Research Database were used.

RESULTS

The most commonly performed operations which were related to vocal fold paralysis in Taiwan were, in descending order of frequency, thyroid, cervical spine, cardiac, thoracic (esophagectomy), and parathyroid operations. The operations that put laryngeal nerves at risk (ONRs) most commonly associated with a diagnosis of UVFP were, in descending order of frequency, thoracic, thyroid, parathyroid, cardiac, and cervical spine. For both UVFP and BVFP, the most commonly associated age group was 51 to 60. For both UVFP and BVFP, the more commonly associated sex was women. Increased length of stay was associated with a higher incidence of UVFP and BVFP. Charlson medical co-morbidity index (CCI) was not associated with UVFP but BVFP was associated with higher Charlson medical co-morbidity scores.

CONCLUSIONS

Thyroid operations, age 51 to 60, longer hospital stays are associated with vocal fold paralysis. Overall women are more surgically affected than men. This is the first population-based study of iatrogenic vocal fold paralysis.

REM-related obstructive sleep apnea and vertigo: A retrospective case-control study

Background

In recent population-based case-control studies, sleep apnea was significantly associated with a higher incidence (hazard ratio, 1.71) of vertigo and the risk of tinnitus was found to increase 1.36 times in patients with sleep apnea. The possibility that obstructive sleep apnea (OSA) might affect neurotological consequences was not noticed, until studies using polysomnography (PSG) for these patients.

Objectives

The purpose of this study was to investigate the relationship between vertigo and OSA.

Methods

The collected data among patients from May 1st, 2018 to October 31th, 2018 at Shuang Ho Hospital. Eligibility criteria included an age older than 20 years, a diagnosis of obstructive sleep apnea. The diagnosis of OSA was defined as an oxygen desaturation index of at least 5, was established with the use of polysomnographic examination at hospital. Patients were excluded from the study if they had head injury, brain tumour, headache history and hearing loss. Patients who had vertigo were labeled as Vertigo group. In the other hand, patients who had no dizziness were labeled as control group. 58 patients were in the Vertigo group, and 113 were in the control group.

Results

After PSG examination, 58 patients who had vertigo, were diagnosed OSA (29 males, average age = 57.07 years old, BMI = 26.64, RDI = 24.69, ESS = 8.65), and 24 patients of them (41.3%) were REM-related OSA. Meanwhile, in the control group, 113 patients had OSA (92male, average age = 49.66 years old, BMI = 26.06, RDI = 35.19, ESS = 11.43), and 18 patients of them (15.9%) were REM-related OSA (Table 1). Therefore, patient who had vertigo, would have higher proportion of REM OSA (P<0.001).

Conclusions

The vertigo patients have a higher rate of REM-related OSA, and the acceptance rate to CPAP use is low. Further research is needed to explore novel therapeutic approaches, or combination of currently available non-CPAP therapies, in patients with REM OSA.

Effects of Hearing Disability on the Employment Status Using WHODAS 2.0 in Taiwan

The aim of this study was to explore the association between employment status and World Health Organization Disability Assessment Schedule, Second Edition (WHODAS 2.0) scores of working-age subjects with hearing impairment. The data of 18,573 working-age subjects (age ≥ 18 and <65 years) with disabling hearing impairment were obtained from the Taiwan Data Bank of Persons with Disability (TDPD) for the period from 11 July 2012 to 31 October 2018. Demographic data and WHODAS 2.0 scores for each domain were analyzed to identify their relationship with employment status. Unemployed subjects with disabling hearing impairment had higher WHODAS 2.0 scores in all domains compared with the employed subjects. Binary logistic regression revealed that older age, female sex, lower educational level, institutional residence, rural residence, lower family income, and moderate to severe impairment were more strongly associated with unemployment status. The data in this large population-based study offer comprehensive information on important factors associated with the employment status of people with disabling hearing impairment. Early identification of risks of unemployment of patients with hearing impairment can raise awareness for aggressive community and government campaigns regarding public health to improve the self-confidence, social participation, and related psycho-social wellbeing of people.

Causes of Vocal Fold Paralysis

BACKGROUND

Vocal fold paralysis (VFP) can result from a variety of diseases or surgeries and has various causes. This study determined concurrent etiologies in patients who were treated in a teaching hospital (tertiary medical center).

METHODS

A retrospective review of medical records of patients with VFP from September 2010 to December 2019 was performed to determine the etiology. Patients with laryngeal/hypopharyngeal malignancies, those with incomplete examination and follow-up data were excluded from the study. During the follow-ups, cases involving recovery were also excluded.

RESULTS

One hundred and ninety-four patients with a determined etiology were included: 113 males and 81 females. Unilateral VFP was present in 178 patients, and 16 presented with bilateral VFP. The causes of unilateral VFP were surgical for 61.3%, neoplastic for 17.5%, idiopathic for 10.3%, traumatic for 1.5%, central for 4.7%, cardiovascular for 2%, radiation-induced for 1.5%, and inflammatory for 1%. Thyroidectomy was the most common surgery for unilateral VFP and was the cause for 54 patients. Lung cancer was responsible for 15 cases and was the most common neoplastic etiology of unilateral VFP. For those who presented with bilateral VFP, surgery was the most common cause and accounted for 56.3% of the incidences. In terms of gender, surgery was the most common cause for both sexes, accounting for 62 of 113 male patients and 57 of 81 female patients. Four cases recovered during the follow-ups and these were excluded.

CONCLUSION

Surgery and in particular, thyroidectomy, was the most common cause of VFP for these series. Central nervous system disorders were the cause of VFP (4.5%). Central nervous system disorders, especially cerebrovascular accidents that induced VFP, could not be neglected. Radiation-induced cranial nerve paralysis in the head and neck cancer was possible causes. The percentage for the causes of unilateral VFP, surgery increased and the percentage for neoplasm decreased for Taiwan.

A Tympanic Membrane Cholesteatoma: A Case Report and Literature Review

A 45-year-old female complained of right hearing loss with fullness in recent months. She underwent right tympanoplasty type I about 4 years ago. On physical and otoscopic examination, a pearl-like mass about 3 x 4 mm in size over central part of right ear drum was noted. Pure tone audiometry test showed 35 decibel (dB) average hearing loss of right ear, and 20 dB of left ear. Tympanogram test showed bilateral type A. Computed tomography with thin cuts of the temporal bone revealed a 3 x 4 mm soft tissue mass over central part of right ear drum. Excision of the mass under microscope was smoothly done. A cholesteatoma was confirmed by pathology. She was uneventful during a regular follow-up. Cholesteatomas are benign collections of keratinized squamous epithelium within the middle ear. A cholesteatoma usually occurred in middle ear cavity or mastoid region, sometimes in external auditory canal. Tympanic membrane cholesteatomas were seldom reported.

The Epidemiology of Benign Voice Disorders in Taiwan: A Nationwide Population-Based Study

OBJECTIVE

Because there are few population-based studies regarding the epidemiology of benign voice diseases, the present study used a nationwide population-based claims database (the National Health Insurance Research Database) to investigate the epidemiology of benign voice diseases among the general adult population in Taiwan.

METHODS

Study participants were retrieved for those patients who were 20 to 90 years old with a diagnosis of benign voice diseases that were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes from 2006 to 2014. Patient visits were grouped into infectious (ICD-9-CM: 012.3, 032.3, 034.0, 090.5, 095.8,101, 464.0, 464.20, 464.21, 465.x, 476.0, 476.1) and noninfectious (ICD-9-CM: 306.1, 478.3x, 478.4, 478.5, 748.3, 784.4x) dysphonia groups.

RESULTS

Benign voice disorders have a prevalence of approximately 3.6% in Taiwan as of 2014. The year-to-year prevalence decreased gradually in the query period. Infectious dysphonia diagnoses were higher than noninfectious ones. Dysphonia caused by noninfectious diagnoses was most prevalent in the 60 to 79 years age group. Dysphonia caused by infectious diagnoses was highest in 20 to 39 years group. Noninfectious dysphonia diagnoses were more common in women.

CONCLUSION

The prevalence of voice disorders among the adult population in Taiwan was 3.6% in 2014. Voice disorders are more common in women and occur primarily in the 20 to 39 years age group. Infectious dysphonia is more common than noninfectious dysphonia. The results may be underestimated due to limitation of the database. This is the first population-based epidemiology study of adult voice disorders.

Vardenafil inhibiting parasympathetic function of tracheal smooth muscle

BACKGROUND

Levitra, a phosphodiesterase-5 (PDE5) inhibitor, is the trade name of vardenafil. Nowadays, it is applied to treatment of erectile dysfunction. PDE5 inhibitors are employed to induce dilatation of the vascular smooth muscle. The effect of Levitra on impotency is well known; however, its effect on the tracheal smooth muscle has rarely been explored. When administered for sexual symptoms via oral intake or inhalation, Levitra might affect the trachea.

METHODS

This study assessed the effects of Levitra on isolated rat tracheal smooth muscle by examining its effect on resting tension of tracheal smooth muscle, contraction caused by 10^-6 M methacholine as a parasympathetic mimetic, and electrically induced tracheal smooth muscle contractions.

RESULTS

The results showed that adding methacholine to the incubation medium caused the trachea to contract in a dose-dependent manner. Addition of Levitra at doses of 10^-5 M or above elicited a significant relaxation response to 10^-6 M methacholine-induced contraction. Levitra could inhibit electrical field stimulation-induced spike contraction. It alone had minimal effect on the basal tension of the trachea as the concentration increased.

CONCLUSION

High concentrations of Levitra could inhibit parasympathetic function of the trachea. Levitra when administered via oral intake might reduce asthma attacks in impotent patients because it might inhibit parasympathetic function and reduce methacholine-induced contraction of the tracheal smooth muscle.

Influence of visual impairment and hearing impairment on functional dependence status among people in Taiwan-An evaluation using the WHODAS 2.0 score

BACKGROUND

Visual impairment (VI) and hearing impairment (HI) are the two most common types of sensory disability encountered clinically. However, VI and HI result in different limitations in daily life. We assessed the level of functioning in patients with VI or HI based on the International Classification of Functioning, Disability, and Health.

METHODS

This nationwide, cross-sectional study included 312 people with VI and 540 people with HI. Each participant's degree of functioning and disability was evaluated using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). The standardized WHODAS 2.0 scores ranged from 0 (least difficulty) to 100 (most difficulty).

RESULTS

Patients with VI and those with HI had a mean (±standard error) 32-item WHODAS 2.0 score of 42.4 ± 2.9 and 27.1 ± 1.6, respectively. The degree of restriction was positively related to the level of VI. Specifically, the patients with VI and a WHODAS 2.0 score of 33.7-35.3 or higher were likely to experience barriers to accessing mobility products, communication products, and education products. Furthermore, patients with a score of 42.9 or higher might experience barriers to accessing ingestion products and living products.

CONCLUSION

WHODAS 2.0 scores are strongly correlated with the severity of VI. Mild VI should be targeted for treatment and referral as early as possible. Compared with the patients with HI, the patients with VI more frequently experience barriers to accessing environmental factors.

Enhanced basal tension in isolated rat tracheal smooth muscle stimulated by electric field stimulation under low temperature

Exposure to cold causes cutaneous vasoconstriction to reduce body heat loss, while the airway warms up the inspired cold air, thus suggesting that cooling might evoke a response in tracheal smooth muscle different from that in cutaneous blood vessels. The aim of this study was to evaluate the effect of temperature on isolated rat trachea, with or without electric field stimulation (EFS). Tissue bath for isolated trachea was used. An in vitro isometric contraction of trachea from healthy male Sprague-Dawley rat (body weight: ≥ 200 g) was continuously recorded. Tension in strips of rat trachea that were untreated and treated with EFS, was continuously recorded in stepwise manner at temperatures varying from 37 °C to 7 °C or from 7 °C to 37 °C. Results indicated that descent and re-ascent of temperature produced temperature-dependent tension changes. Basal tension of the trachea decreased when temperature was reduced if EFS was not applied. EFS-induced spike contraction decreased when temperature was reduced, while basal tension increased at the same time. We concluded that low temperature induced rapid and reproducible contraction in isolated rat tracheal strip only if EFS was applied. Increasing temperature reduced basal tension and enhanced EFS-induced spike contraction of the trachea at the same time.

Menthol inhibiting parasympathetic function of tracheal smooth muscle

Menthol is used as a constituent of food and drink, tobacco and cosmetics nowadays. This cold receptor agonist has been used as a nasal inhalation solution in the daily life. The effect of menthol on nasal mucosa in vivo is well known; however, the effect of the drug on tracheal smooth muscle has been rarely explored. Therefore, during administration of the drug for nasal symptoms, it might also affect the trachea via oral intake or inhalation. We used our preparation to test the effectiveness of menthol on isolated rat tracheal smooth muscle. A 5 mm long portion of rat trachea was submersed in 30 ml Krebs solution in a muscle bath at 37ºC. Changes in tracheal contractility in response to the application of a parasympathetic mimetic agent were measured using a transducer connected to a Pentium III computer equipped with polygraph software. The following assessments of menthol were performed: (1) effect on tracheal smooth muscle resting tension; (2) effect on contraction caused by 10^-6 M methacholine as a parasympathetic mimetic; (3) effect of the drug on electrically induced tracheal smooth muscle contractions. Results indicated that addition of a parasympathetic mimetic to the incubation medium caused the trachea to contract in a dose-dependent manner. Addition of menthol at doses of 10^-5 M or above elicited a relaxation response to 10^-6 M methacholine-induced contraction. Menthol could also inhibit electrical field stimulation (EFS) induced spike contraction. However, it alone had a minimal effect on the basal tension of trachea as the concentration increased. We concluded that the degree of drug-induced tracheal contraction or relaxation was dose-dependent. In addition, this study indicated that high concentrations of menthol might actually inhibit parasympathetic function of the trachea.

Serum level of interleukin-21 is elevated in chronic rhinosinusitis

BACKGROUND

Chronic rhinosinusitis (CRS) is an inflammatory disease of the sinuses and mucosa with unclear pathogenesis. Interleukin (IL)-21 is mainly expressed in activated cluster of differentiation (CD)4(+) T cells and has potent regulatory effects on the immune system.

OBJECTIVE

This study is to determine whether IL-21 in the blood is correlated with CRS.

METHODS

The blood samples from CRS patients and normal controls were analyzed in correlation with clinical features. The eosinophil percentage was counted, and serum levels of total immunoglobulin E (IgE) and IL-21 were analyzed by enzyme-linked immunosorbent assay (ELISA). In addition, IL-21 and interferon (IFN)-γ secreted from stimulated peripheral blood mononuclear cells (PBMCs) were measured by ELISA, and their mRNA expression levels were analyzed by real-time quantitative polymerase chain reaction (RT-qPCR). Disease severity was scored based on computed tomography (CT) scan, nasal endoscopy, and global osteitis scoring scale (GOSS).

RESULTS

A total of 55 CRS and 37 healthy subjects were recruited. The average levels of serum total IgE were 20 kU/L in normal group, 290 kU/L in CRS with nasal polys (CRSwNP), and 187 kU/L in CRS without nasal polys (CRSsNP). IL-21 levels were 28 pg/mL in normal group, 54 pg/mL in CRSwNP, and 71 pg/mL in CRSsNP. Both IgE and IL-21 were significantly elevated in both CRS patient subgroups. However, no significant difference was found between these two patient subgroups. The serum IL-21 levels correlated well with the disease severity in the patients. In addition, the secreted IL-21 was enhanced significantly in the patient's PBMCs stimulated by phytohemagglutin (PHA).

CONCLUSION

IL-21 could be a target for diagnosis and treatment of CRS.

Dendritic cells respond to nasopharygeal carcinoma cells through annexin A2-recognizing DC-SIGN

Dendritic cells (DCs) play an essential role in immunity and are used in cancer immunotherapy. However, these cells can be tuned by tumors with immunosuppressive responses. DC-specific intercellular adhesion molecule 3-Grabbing Nonintegrin (DC-SIGN), a C-type lectin expressed on DCs, recognizes certain carbohydrate structures which can be found on cancer cells. Nasopharyngeal carcinoma (NPC) is an epithelial cell-derived malignant tumor, in which immune response remains unclear. This research is to reveal the molecular link on NPC cells that induces the immunosuppressive responses in DCs. In this article, we report identification of annexin A2 (ANXA2) on NPC cells as a ligand for DC-SIGN on DCs. N-linked mannose-rich glycan on ANXA2 may mediate the interaction. ANXA2 was abundantly expressed in NPC, and knockdown of ANXA2 suppressed NPC xenograft in mice, suggesting a crucial role of ANXA2 in NPC growth. Interaction with NPC cells caused DC-SIGN activation in DCs. Consequently DC maturation and the proinflammatory interleukin (IL)-12 production were inhibited, and the immunosuppressive IL-10 production was promoted. Blockage of either DC-SIGN or ANXA2 eliminated the production of IL-10 from DCs. This report suggests that suppression of ANXA2 at its expression or glycosylation on NPC may improve DC-mediated immunotherapy for the tumor.

The effect of temperature on basal tension and thyroarytenoid muscle contraction in an isolated rat glottis model

The pitch of voice is closely related to the vocal fold tension, which is the end result of coordinated movement of the intralaryngeal muscles, and especially the thyroarytenoid muscle. It is known that vocal quality may be affected by surrounding temperature; however, the effect of temperature on vocal fold tension is mostly unknown. Thus, the aim of this study was to evaluate the effect of temperature on isolated rat glottis and thyroarytenoid muscle contraction induced by electrical field stimulation. In vitro isometric tension of the glottis ring from 30 Sprague-Dawley rats was continuously recorded by the tissue bath method. Electrical field stimulation was applied to the glottis ring with two wire electrodes placed parallel to the glottis and connected to a direct-current stimulator. The tension changes of the rat glottis rings that were either untreated or treated with electrical field stimulation were recorded continuously at temperatures from 37 to 7 °C or from 7 to 37 °C. Warming from 7 to 37 °C increased the basal tension of the glottis rings and decreased the electrical field stimulation-induced glottis ring contraction, which was chiefly due to thyroarytenoid muscle contraction. In comparison, cooling from 37 to 7 °C decreased the basal tension and enhanced glottis ring contraction by electrical field stimulation. We concluded that warming increased the basal tension of the glottis in vitro and decreased the amplitude of electrical field stimulation-induced thyroarytenoid muscle contraction. Thus, vocal pitch and the fine tuning of vocal fold tension might be affected by temperature in vivo.

Cryptococcal infection of the vocal folds

Cryptococcosis of the larynx is rare. In this manuscript we present a case of laryngeal cryptococcosis with a clear history of pigeon exposure. Cryptococcal laryngitis may present as hoarseness without other typical symptoms, even in immunocompetent individuals.

Risk of stroke among patients with rhinosinusitis: a population-based study in Taiwan

BACKGROUND

Research has found evidence that chronic inflammation may promote atherosclerotic disease. The purpose of this study was to test the hypothesis that rhinosinusitis is a risk factor for stroke.

METHODS

This prospective cohort study comprised patients recorded on the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005) who had received a diagnosis of rhinosinusitis (n = 53,653) between January 1, 2004 and December 31, 2005. A control group (1:4) drawn from the same database was matched for age and gender (n = 214,624). Each patient was followed up using data entered until the end of 2006. Cox proportional hazard regressions were performed to evaluate the hazard ratios (HRs) after adjusting for potential confounding factors.

RESULTS

We found that patients with rhinosinusitis were more likely to suffer strokes than the control population, after adjusting for potential confounders (adjusted HR, 1.39; 95% confidence interval [CI], 1.28~1.50). The HR of stroke was 1.39 (95% CI, 1.28~1.51) for acute sinusitis patients, and 1.34 (95% CI, 1.04~1.74) for chronic sinusitis patients.

CONCLUSION

Both acute and chronic sinusitis are risk factors or markers for stroke that is independent of traditional stroke risk factors. Further research in this important area of epidemiology is warranted.

Risk of myocardial infarction in patients with rhinosinusitis

Research has indicated that inflammation promote all phases of atherosclerosis. The current study tested the hypothesis that rhinosinusitis is a risk marker for myocardial infarction (MI). Data on the general population were obtained from the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005). The study cohort comprised patients who had received a recorded diagnosis of rhinosinusitis (N = 52,930) between January 1, 2004 and December 31, 2004. The comparison group consisted of patients who had not received a rhinosinusitis diagnosis, and who were matched for age and sex with the study group at a ratio of 4 controls to 1 study patient (1:4) (N = 211,720). Each patient's condition was followed using database entries until the end of 2006. Cox proportional hazard regressions were used to evaluate the 3-year MI-free survival rates, after adjusting for known confounding factors. We found that patients with rhinosinusitis were more likely than the control group to have MI, after adjusting for potential confounders [adjusted hazard ratio (HR), 1.84; 95% confidence interval (CI), 1.44 ∼ 2.40]. Of the total 264 650 patients, 290 experienced MI during the 3-year follow-up period, including 8 acute sinusitis patients, 77 chronic sinusitis patients, and 205 control patients. The incidence rate of MI was 6.19 (95% CI 5.01-7.65) per 10,000 person-years for rhinosinusitis patients, compared to 3.51 (95% CI, 3.06-4.02) for the control patients. From this study, rhinosinusitis may be associated with MI. Further research in this important area of public health is warranted.

Plasma RANTES and eotaxin levels are correlated with the severity of chronic rhinosinusitis

Eosinophilia occurs in up to 75-90% of nasal polyps in Caucasians. The chemokines eotaxin and RANTES increase eosinophil recruitment, activation, and survival, and these chemokines are significantly expressed in nasal polyps. We hypothesized that eotaxin and RANTES plasma levels might be correlated with disease severity. We compared the eotaxin and RANTES plasma levels in 20 Taiwanese patients with chronic rhinosinusitis and nasal polyps and 20 Taiwanese healthy controls. Eotaxin and RANTES plasma levels were measured by ELISA and disease severity was scored by CT scans. Compared to controls, patients with nasal polyps had significantly elevated plasma levels of eotaxin and RANTES and increased peripheral blood eosinophils (p < 0.001). Eotaxin plasma levels were significantly correlated with disease severity in patients with chronic rhinosinusitis to a greater extent than were RANTES levels. RANTES and eotaxin levels were also positively correlated with the percentages of peripheral blood eosinophils. Eotaxin plasma levels are significantly correlated with disease severity in Taiwanese patients with nasal polyposis to a greater degree than are RANTES levels. Additional studies are needed to assess whether eotaxin plasma levels can be used to monitor disease progression and attenuation.

Regulation of MMP-3 expression and secretion by the chemokine eotaxin-1 in human chondrocytes

BACKGROUND

Osteoarthritis (OA) is characterized by the degradation of articular cartilage, marked by the breakdown of matrix proteins. Studies demonstrated the involvement of chemokines in this process, and some may potentially serve as diagnostic markers and therapeutic targets; however, the underlying signal transductions are not well understood.

METHODS

We investigated the effects of the CC chemokine eotaxin-1 (CCL11) on the matrix metalloproteinase (MMP) expression and secretion in the human chondrocyte cell line SW1353 and primary chondrocytes.

RESULTS

Eotaxin-1 significantly induced MMP-3 mRNA expression in a dose-dependent manner. Inhibitors of extracellular signal-regulated kinase (ERK) and p38 kinase were able to repress eotaxin-1-induced MMP-3 expression. On the contrary, Rp-adenosine-3',5'-cyclic monophosphorothioate (Rp-cAMPs), a competitive cAMP antagonist for cAMP receptors, and H-89, a protein kinase A (PKA) inhibitor, markedly enhanced eotaxin-1-induced MMP-3 expression. These results suggest that MMP-3 expression is specifically mediated by the G protein-coupled eotaxin-1 receptor activities. Interestingly, little amount of MMP-3 protein was detected in the cell lysates of eotaxin-1-treated SW1353 cells, and most of MMP-3 protein was in the culture media. Furthermore we found that the eotaxin-1-dependent MMP-3 protein secretion was regulated by phospholipase C (PLC)-protein kinase C (PKC) cascade and c-Jun N-terminal kinase (JNK)/mitogen-activated protein (MAP) kinase pathways. These data indicate a specific regulation of MMP-3 secretion also by eotaxin-1 receptor activities.

CONCLUSIONS

Eotaxin-1 not only induces MMP-3 gene expression but also promotes MMP-3 protein secretion through G protein-coupled eotaxin-1 receptor activities. Chemokines, such as eotaxin-1, could be a potential candidate in the diagnosis and treatment of arthritis.

Physician and hospital characteristics related to length of stay for sudden sensorineural hearing loss patients

The treatment of sudden sensorineural hearing loss (SSNHL) has remained one of the most controversial issues in otolaryngology, and there are wide disparities between clinicians' treatment methods for SSNHL. Using five-year population-based data, we explored the relationship between physician and hospital characteristics and the length of stay (LOS) for SSNHL patients in Taiwan. The dataset was derived from the National Health Insurance Research Database. The patients in the study sample were identified by a principal diagnosis of sudden hearing loss. A total of 8712 hospitalization cases between 1998 and 2002 inclusive were included. Multiple regression analyses were performed in order to explore the relationship between physician and hospital characteristics and LOS, adjusting for patients' age and gender, as well as complications or comorbidities. The mean LOS for the duration of the study period was 5.62 days, while the regression analysis showed that, as compared to district hospitals, the LOS in medical centers and regional hospitals was 0.42 and 0.37 days longer, respectively (all p < 0.001). The analysis also revealed that the LOS was 0.71 days shorter for patients who were attended by physicians specializing in otolaryngology than for those attended by physicians specializing in other areas (p < 0.001). This study concludes that there is indeed a relationship between physician and hospital characteristics and the LOS for SSNHL patients. The results of this study serve to highlight the importance of developing treatment protocols for SSNHL so as to reduce the variation in physician or hospital behavior.

Sudden sensorineural hearing loss increases the risk of stroke: a 5-year follow-up study

BACKGROUND AND PURPOSE

No previous study has investigated the incidence or risk of cerebrovascular diseases developing after the sudden sensorineural hearing loss (SSNHL). This study sets out to estimate the risk of stroke development among SSNHL patients during a 5e-year follow-up period after hospitalization for acute episodes of SSNHL.

METHODS

Our study design features a study cohort and a comparison cohort. The study cohort consists of all patients hospitalized with a principal diagnosis of sudden hearing loss (n=1,423), whereas the control cohort comprised all patients hospitalized for an appendectomy in 1998 (n=5692) as a surrogate for the general population. Each patient was tracked from hospitalization in 1998 until the end of 2003. Cox proportional hazard regressions were performed as a means of computing the 5-year stroke-free survival rates after adjustment for possible confounding factors.

RESULTS

Of the total sample, 621 patients (8.7%) had strokes during the 5-year follow-up period: 180 (12.7% of the SSNHL patients) from the study cohort and 441 (7.8% of patients undergoing an appendectomy) from the control cohort. After adjusting for other factors, the hazard of stroke during the 5-year follow-up period was 1.64-times (95% CI, 1.31 to 2.07; P<0.001) greater for SSNHL patients than for appendectomy patients.

CONCLUSIONS

Our findings suggest that SSNHL can be an early warning sign of impending stroke. We suggest that SSNHL patients should undergo a comprehensive hematologic and neurological examination to help clinicians identify those potentially at risk for stroke developing in the near future.

Sudden Sensorineural Hearing Loss: Evidence from Taiwan

OBJECTIVE

This study uses 5-year population data to determine the incidence rate of sudden sensorineural hearing loss (SSNHL) in Taiwan, taking into consideration the age and gender of patients, as well as seasonal variations.

STUDY DESIGN

A retrospective cross-sectional study.

METHOD

The data used is from the Taiwan National Health Insurance Research Database covering the period from 1998 to 2002. A total of 9,267 sample patients were identified from the database by a principal diagnosis of unspecified sudden hearing loss (ICD-9-CM code 3882). The autoregressive integrated moving average (ARIMA) method was also carried out in order to identify any variations in the monthly incidence rates of SSNHL.

RESULTS

We find that for the period under examination, gender-specific incidence rates per 100,000 of the population were 8.85 for males, and 7.79 for females, and that there was an increase in age-specific SSNHL incidence with age. The ARIMA test for seasonality was found to be significant for the whole sample. Of all the seasons in Taiwan, the highest SSNHL incidence rates were found in autumn.

CONCLUSIONS

Our finding of significant variations in the monthly incidence of SSNHL provides valuable information for otolaryngologists and public health officials, creating an awareness of periods of a potential increased risk of SSNHL.

The effects of weather on the incidence of sudden sensorineural hearing loss: a 5-year population-based study

OBJECTIVE

This study utilizes 5-year population data to examine the association between weather conditions and the incidence of sudden sensorineural hearing loss (SSNHL) in Taiwan with a specific focus on ambient temperature, relative humidity, atmospheric pressure, rainfall and total hours of sunshine.

METHOD

The data, covering the period from 1998 to 2002, is sourced from the Taiwan National Health Insurance Research Database (NHIRD), with a total of 8712 first-time admissions being identified from the database by a principal diagnosis of unspecified sudden hearing loss (ICD-9-CM code 3882). After controlling for time trend effects, this study adopted the autoregressive integrated moving average regression method as a means of evaluating the effects of climatic and monthly factors on SSNHL incidence rates.

RESULTS

Although significant associations were found between ambient temperature, relative humidity and the SSNHL incidence rates for the total population, after adjusting for seasonality, months and trends, the significant relationship between SSNHL incidence rates and the climatic parameters disappeared.

CONCLUSIONS

This study has demonstrated that after adjusting for seasonality, months and trends, there is no significant relationship between monthly SSNHL incidence rates and weather conditions. Therefore, the theory that weather is a triggering factor in SSNHL pathogenesis is not supported by this study.

Intraparotid Kikuchi-Fujimoto disease masquerading as a parotid gland tumor

The Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a self-limiting lesion of unknown cause first described in 1972 independently by Kikuchi and Fujimoto et al. This self-limiting disorder usually occurs in Asian women in their late 20s or early 30s. Typically, it runs a benign course and appears to resolve spontaneously 1 to 6 months after definite diagnosis. The Kikuchi-Fujimoto disease usually manifests as a localized cervical lymphadenopathy; therefore, most patients with this disease are seen in ears, nose, and throat practice. Nodal involvement other than in the neck area or extranodal involvement is rare. In this situation, however, the Kikuchi-Fujimoto disease is easily confused with other less-benign conditions. We describe a case of Kikuchi-Fujimoto disease in a 30-year-old man that presented as a parotid gland tumor. This is the third study to document intraparotid Kikuchi-Fujimoto disease in the English literature. Our report illustrates the clinical features of this unusual condition and emphasizes potential confusion with other diagnoses.

Pediatric Kikuchi-Fujimoto disease masquerading as a submandibular gland tumor

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a rare disorder that typically affects the cervical lymph nodes. The disease usually occurs in women in their late 20s or early 30s. Reports in the pediatric literature are sparse. Most authors consider Kikuchi-Fujimoto disease as a self-limiting disorder that requires no specific management but long-term follow-up. The clinical features of Kikuchi-Fujimoto disease are easily confused with other less-benign conditions. Thus, an early biopsy is instrumental in making definite diagnosis and preventing unnecessary investigations. We describe a case of Kikuchi-Fujimoto disease in an 8-year-old boy which presenting as a submandibular gland tumor. The case illustrates the clinical features of this unusual condition and emphasizes the potential confusion with other diagnoses.

Long-term oncological results in 47 cases of jugular paraganglioma surgery with special emphasis on the facial nerve issue

Oncological and functional results were assessed in 47 type C and/or D jugular paraganglioma operated on between 1984 and 1998 using the classical infratemporal fossa type A approach (mean follow-up = 66 months). In 24 instances, however, the facial nerve was not re-routed. Total resection was achieved in 33 cases (70 per cent). In 25 patients available for follow-up this resulted in a 92 per cent cure rate while two patients (eight per cent) developed recurrences that are being followed-up clinically and radiologically. Sub-total resection, leaving infracentimetric tumour remnants after being coagulated, was achieved in 14 cases (30 per cent). In 11 patients available for follow-up, only three cases developed tumour regrowth (27 per cent) that was controlled by salvage irradiation or surgery while in the other cases tumour remnants remained stable (73 per cent). Symptomatic post-operative lower cranial nerve impairment was observed in 23 per cent. When results were analysed depending on whether the facial nerve had been re-routed (n = 18) or not (n = 24), the incidence of facial paralysis HB grade III or more at one year was 33 per cent and eight per cent, respectively. Total resection was achieved in 56 per cent when the facial nerve was re-routed versus 75 per cent when it was not, the difference being due to a higher incidence of large tumours in the first group. The present study suggests that: 1) surgical resection of jugular paraganglioma provides overall satisfactory results, i.e. a 86 per cent rate of either cure or tumour remnant stabilization, but carries a significant risk of iatrogeny; 2) complete tumour removal should not be attempted, especially in patients over 60 years of age with no pre-operative neurological deficits, since leaving infracentimetric tumour remnants has no major detrimental effect on the final outcome; 3) facial nerve transposition carries a significant risk of cosmetic sequelae while it does not provide significant advantages in terms of tumour resection and long-term oncological control.