Predicting the distribution coefficient of cesium in solid phase groups using machine learning

The migration and retention of radioactive contaminants such as 137Cesium (137Cs) in various environmental media pose significant long-term storage challenges for nuclear waste. The distribution coefficient (Kd) is a critical parameter for assessing the mobility of radioactive contaminants and is influenced by various environmental conditions. This study presents machine-learning models based on the Japan Atomic Energy Agency Sorption Database (JAEA-SDB) to predict the Kd values for Cs in solid phase groups. We used three different machine learning models: random forest (RF), artificial neural network (ANN), and convolutional neural network (CNN). The models were trained on 14 input variables from the JAEA-SDB, including factors such as the Cs concentration, solid-phase properties, and solution conditions, which were preprocessed by normalization and log-transformation. The performances of the models were evaluated using the coefficient of determination (R2) and root mean squared error (RMSE). The RF, ANN, and CNN models achieved R2 values greater than 0.97, 0.86, and 0.88, respectively. We also analyzed the variable importance of RF using an out-of-bag (OOB) and a CNN with an attention module. Our results showed that the environmental media, initial radionuclide concentration, solid phase properties, and solution conditions were significant variables for Kd prediction. Our models accurately predict Kd values for different environmental conditions and can assess the environmental risk by analyzing the behavior of radionuclides in solid phase groups. The results of this study can improve safety analyses and long-term risk assessments related to waste disposal and prevent potential hazards and sources of contamination in the surrounding environment.

Deep learning-based efficient drone-borne sensing of cyanobacterial blooms using a clique-based feature extraction approach

Recent advances in remote sensing techniques provide a new horizon for monitoring the spatiotemporal variations of harmful algal blooms (HABs) using hyperspectral data in inland water. In this study, a hierarchical concatenated variational autoencoder (HCVAE) is proposed as an efficient and accurate deep learning (DL) based bio-optical model. To demonstrate its usefulness in retrieving algal pigments, the HCVAE is applied to bloom-prone regions in Daecheong Lake, South Korea. By abstracting the similarity between highly related features using layer-wise clique-based latent-feature extraction, HCVAE reduces the computational loads in deriving outputs while preventing performance degradation. Graph-based clique-detection uses information theory-based criteria to group the related reflectance spectra. Consequently, six latent features were extracted from 79 spectral bands to consist of a multilevel hierarchy of HCVAE that can simultaneously estimate concentrations of chlorophyll-a (Chl-a) and phycocyanin (PC). Despite the parsimonious model architecture, the Chl-a and PC concentrations estimated by HCVAE closely agree with the measured concentrations, with test R2 values of 0.76 and 0.82, respectively. In addition, spatial distribution maps of algal pigments obtained from HCVAE using drone-borne reflectance successfully capture the blooming spots. Based on its multilevel hierarchical architecture, HCVAE can provide the importance of latent features along with their individual wavelengths using Shapley additive explanations. The most important latent features covered the spectral regions associated with both Chl-a and PC. The lightweight neural network DNNsel, which uses only the spectral bands of highest importance in latent-feature extraction, performed comparably to HCVAE. The study results demonstrate the utility of the multilevel hierarchical architecture as a comprehensive assessment model for near-real-time drone-borne sensing of HABs. Moreover, HCVAE is applicable to a wide range of environmental big data, as it can handle numerous sets of features.

The therapeutic effect of hyperbaric oxygen therapy in patients with severe to profound idiopathic sudden sensorineural hearing loss

The optimal treatment for sudden sensorineural hearing loss (SSNHL) is unclear. Hyperbaric oxygen therapy (HBOT) has been suggested as a viable option for treatment of SSNHL as it improves vascular dysfunction. In this study, we evaluated the therapeutic effects of HBOT by retrospectively reviewing the records of 2206 patients with SSNHL. 54 who had received HBOT were selected for the HBOT groups, while 59 age-matched controls who had not were selected for the control groups. The HBOT and control groups were divided into subgroups according to intratympanic steroid (ITS) use. Groups A-D had received oral steroids + HBOT, oral steroids only, oral steroids + ITS + HBOT, and oral steroids + ITS, respectively. Of the 113 SSNHL patients, 21 had diabetes mellitus (DM) (2, 0, 9, and 10 patients in Groups A-D, respectively). There was no notable difference in hearing improvement between patients receiving HBOT and those in the control group. However, among diabetic patients, those who underwent HBOT demonstrated a significant improvement in hearing when compared to the control group. The combination of HBOT and steroids could potentially be beneficial for treating severe to profound SSNHL patients with DM.

Early Assessment of Voice Problems in Post-Thyroidectomy Syndrome Using Cepstral Analysis

Post-thyroidectomy syndrome (PTS), characterized by voice issues after thyroidectomy without recurrent laryngeal nerve injury, was investigated in this study. The Voice Fatigue Index (VFI) and cepstral analysis were employed for subjective and objective voice evaluation. Retrospective analysis involved 96 patients (37 males, 59 females) who underwent thyroidectomy without nerve injury from April 2018 to June 2022. Assessments pre- and post-thyroidectomy included the Voice Handicap Index (VHI) and VFI, along with auditory perceptual, acoustic (including cepstral), aerodynamic, and glottal vibration analyses. In females, although the GRBAS scale showed no significant change, both VHI and VFI increased post-thyroidectomy. Significant correlations were observed between the VHI and VFI in females. Acoustic analysis indicated a decrease in the cepstral peak prominence (CPP) of vowels (/a/) and sentences in females, with significant correlations between changes in the CPP/a/ and VHI/VFI. The maximum fundamental frequency (F0max) exhibited a significant decrease, correlating with the VHI and VFI changes. The VFI demonstrated effectiveness in subjective PTS voice evaluation, comparable to the VHI. The present study highlights the potential of cepstral analysis as an index reflecting subjective voice discomfort, suggesting its promise for a comprehensive PTS voice evaluation.

Automatic classification of microplastics and natural organic matter mixtures using a deep learning model

Several preprocessing procedures are required for the classification of microplastics (MPs) in aquatic systems using spectroscopic analysis. Procedures such as oxidation, which are employed to remove natural organic matter (NOM) from MPs, can be time- and cost-intensive. Furthermore, the identification process is prone to errors due to the subjective judgment of the operators. Therefore, in this study, deep learning (DL) was applied to improve the classification accuracies for mixtures of microplastic and natural organic matter (MP-NOM). A convolutional neural network (CNN)-based DL model with a spatial attention mechanism was adopted to classify substances from their Raman spectra. Subsequently, the classification results were compared with those obtained using conventional Raman spectral library software to evaluate the applicability of the model. Additionally, the crucial spectral band for training the DL model was investigated by applying gradient-weighted class activation mapping (Grad-CAM) as a post-processing technique. The model achieved an accuracy of 99.54%, which is much higher than the 31.44% achieved by the Raman spectral library. The Grad-CAM approach confirmed that the DL model can effectively identify MPs based on their visually prominent peaks in the Raman spectra. Furthermore, by tracking distinctive spectra without relying solely on visually prominent peaks, we can accurately classify MPs with less prominent peaks, which are characterized by a high standard deviation of intensity. These findings demonstrate the potential for automated and objective classification of MPs without the need for NOM preprocessing, indicating a promising direction for future research in microplastic classification.

Treatment Efficacy of Various Maneuvers for Lateral Canal Benign Paroxysmal Positional Vertigo With Apogeotropic Nystagmus: A Randomized Controlled Trial

OBJECTIVES

The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV).

METHODS

We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus.

RESULTS

This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P<0.05). After 4 weeks, the success rates for groups A, B, and C were 90.5%, 92.3%, and 100%, respectively. No significant difference was observed in the success rate across treatment.

METHODS

and periods (P>0.05). However, CuRM was the only method with a 100% treatment success rate.

CONCLUSION

While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term.

Monitoring the vertical distribution of HABs using hyperspectral imagery and deep learning models

Remote sensing techniques have been applied to monitor the spatiotemporal variation of harmful algal blooms (HABs) in many inland waters. However, these studies have been limited to monitor the vertical distribution of HABs due to the optical complexity of inland water. Therefore, this study applied a deep neural network model to monitor the vertical distribution of Chlorophyll-a (Chl-a), phycocyanin (PC), and turbidity (Turb) using drone-borne hyperspectral imagery, in-situ measurement, and meteoroidal data. The pigment concentrations were measured between depths of 0 m and 5.0 m with 0.05 m intervals. Here, four state-of-the-art data-driven model structures (ResNet-18, ResNet-101, GoogLeNet, and Inception v3) were adopted for estimating the vertical distributions of the harmful algal pigments. Among the four models, the ResNet-18 model showed the best performance, with an R² value of 0.70. In addition, Gradient-weighted Class Activation Mapping (Grad-CAM) substantially provided informative reflectance band ranges near 490 nm and 620 nm in the hyperspectral image for the vertical estimation of pigments. Therefore, this study demonstrated that the explainable deep learning model with drone-borne hyperspectral images has the potential to estimate Chl-a, PC, and Turb vertical distributions and to show influential features that contribute to describing the vertical profile phenomena.

Evaluating an on-line cleaning agent for mitigating organic fouling in a reverse osmosis membrane

Cleaning-in-place (CIP) is a representative fouling management process from which the filtration performances of fouled membranes can be recovered. However, CIP can cause significant inefficiency in water production because frequent system restabilization is necessary for cleaning processes. This study applied a newly developed on-line cleaning agent (OCA, a feed water additive for fouling mitigation), to reduce the number of CIP by enhancing water productivity. Reverse osmosis filtration was performed to evaluate the effect of on-line cleaning on the mitigation of organic fouling originating from humic acid (HA) and bovine serum albumin. OCA increased the permeate flux in proportion to OCA concentration. In particular, OCA effectively reduced the fouling layer thickness by 22% when fouling was influenced by HA-Ca²⁺ complexation, increasing water production by 5%. It also had a minor influence on bovine serum albumin fouling, producing a 1.4% increase in permeate flux. Furthermore, the pore blockage-cake filtration model was used to evaluate OCA cleaning performance through the reduction in fouling layer resistance and the growth parameter. The results demonstrated the advantages of OCA utilization for mitigating cake layer development. These findings imply that OCA can be an effective cleaning additive, especially in seawater and groundwater treatment processes with a high proportion of HA and calcium ions.

Comparison of the human microbiome in adults and children with chronic rhinosinusitis

We hypothesized that differences in the microbiome could be a cause of the substantial differences in the symptoms of and treatment options for adult and pediatric patients with chronic rhinosinusitis (CRS). First, we characterized the differences in the nasal microbiomes of pediatric and adult CRS patients. Swabs were obtained from 19 patients with chronic rhinosinusitis (9 children and 10 adults). The bacterial 16S rRNA gene was pyrosequenced to compare the microbiota of the middle meatus. No significant differences were found in species richness and alpha-diversity indices between the two groups. However, in the comparison of diversity between groups using the unweighted pair group method with arithmetic mean (UPGMA) clustering of microbiome taxonomic profiles, we observed a relatively clear separation between the adult and pediatric groups. Actinobacteria had a significantly higher relative abundance in the adult group than in the pediatric group at the phylum level. At the genus level, Corynebacterium showed significantly higher relative abundance in the adult group than in the pediatric group. This is a comparative study between the microbiomes of adult and pediatric CRS patients. We expect this study to be the first step in understanding the pathogenesis of CRS in adults and children using microbiome analysis.

Estimation of heavy metals using deep neural network with visible and infrared spectroscopy of soil

Heavy metal contamination in soil disturbs the chemical, biological, and physical soil conditions and adversely affects the health of living organisms. Visible and near-infrared spectroscopy (VNIRS) shows a potential feasibility for estimating heavy metal elements in soil. Moreover, deep learning models have been shown to successfully deal with complex multi-dimensional and multivariate nonlinear data. Thus, this study implemented a deep learning method on reflectance spectra of soil samples to estimate heavy metal concentrations. A convolutional neural network (CNN) was adopted to estimate arsenic (As), copper (Cu), and lead (Pb) concentrations using measured soil reflectance. In addition, a convolutional autoencoder was utilized as a joint method with the CNN for dimensionality reduction of the reflectance spectra. Furthermore, artificial neural network (ANN) and random forest regression (RFR) models were built for heavy metal estimation. Principal component analysis was utilized for dimensionality reduction of the ANN and RFR models. Among these models, the CNN model with convolutional autoencoder showed the highest accuracies for As, Cu, and Pb estimates, having R² values of 0.86, 0.74, and 0.82, respectively. The convolutional autoencoder disentangled the relevant features of multiple heavy metal elements and delivered robust features to the CNN model, thereby generating relatively accurate estimates.

Feasibility of Powered Intracapsular Tonsillectomy in Pediatric Patients with Tonsil Problem, Including Recurrent Tonsillitis: A Single Surgeon's Experience

INTRODUCTION

Powered intracapsular tonsillectomy (PIT) is a technique that protects the tonsillar capsule by using a microdebrider, resulting in faster wound-healing and reduced suffering. Many studies have found PIT to be effective, particularly in pediatric patients with obstructive sleep apnea (OSA). However, previous studies have not included patients with a history of recurrent tonsillitis.

OBJECTIVE

The aim of this study was to determine the efficacy of PIT in pediatric patients even with a history of recurrent tonsillitis, and therefore, we want to expand the indication for PIT and reveal its safety.

METHODS

A total of 886 pediatric patients underwent PIT between February 2013 and March 2016. All patients rated their postoperative pain using a visual analog scale (VAS) and completed the Korean obstructive sleep apnea (KOSA)-18 questionnaire for assessment of their quality of life (QOL). There were 539 males and 347 females. Their mean age was 6.2 years (range 2-14 years). The majority (77.7%) underwent the operation for OSA, and the rest (22.3%) had a history of recurrent tonsillitis. To compare the efficacy of PIT with traditional tonsillectomy, we selected 191 patients who underwent extracapsular tonsillectomy (ECT), a conventional technique, during the same time period. The median follow-up period was 16.7 months. During the follow-up period, instances of delayed bleeding and recurrent pharyngitis were monitored.

RESULTS

In comparison to the patients who underwent ECT, the PIT group showed significantly fewer cases of postoperative bleeding (p = 0.027). Thirteen patients in the PIT group (1.5%) visited the hospital during the follow-up period for pharyngitis, while 8 in the ECT group (4.2%) visited for pharyngitis. The mean postoperative pain score, as assessed by a VAS, was 4.6 ± 3.2, and pain improved within an average of 2.9 days after surgery in the PIT group. The mean KOSA-18 score for the QOL of the patients was 65.9 preoperatively and 35.6 postoperatively in the PIT group.

CONCLUSIONS

Pediatric tonsillectomy using PIT is valid for reducing postoperative pain and improving the QOL of OSA patients. PIT is also effective and safe for patients with a history of recurrent tonsillitis.

Analysis of the Microbiome in the Adenoids of Korean Children with Otitis Media with Effusion

OBJECTIVES

The adenoid pad, which is located between the orifice of the Eustachian tube (ET) and posterior nasal cavity, can affect the development of otitis media with effusion (OME) because of its anatomical location. The aim of the present study was to evaluate adenoid microbial colonization through 16S ribosomal RNA (rRNA) pyrosequencing, an advanced molecular technique, and to document the relationship with OME.

MATERIALS AND METHODS

Adenoid samples were collected using sterile cotton from 32 children during ventilation tube insertion. Sixteen children with OME who underwent tonsillectomy and adenoidectomy due to obstructive symptoms were assigned to the OME group and sixteen children without OME were assigned to the control group. We performed a 16S rRNA-based culture-independent survey of bacterial communities using the MiSeq platform.

RESULTS

The diversity index, mean operational taxonomic units, and Shannon index were lower in the OME group than those in the control group. A taxonomic analysis showed differences in microbiota distribution between the OME and control groups at the phylum, genus, and species levels. The analysis, which was based on weighted UniFrac distances, revealed differences in microbial composition between the two groups.

CONCLUSION

Bacterial community analysis using 16S rRNA pyrosequencing allows us to understand the relationship between the microbial communities of adenoids and the development of OME better.

Automatic detection of tympanic membrane and middle ear infection from oto-endoscopic images via convolutional neural networks

Convolutional neural networks (CNNs), a popular type of deep neural network, have been actively applied to image recognition, object detection, object localization, semantic segmentation, and object instance segmentation. Accordingly, the applicability of deep learning to the analysis of medical images has increased. This paper presents a novel application of state-of-the-art CNN models, such as DenseNet, to the automatic detection of the tympanic membrane (TM) and middle ear (ME) infection. We collected 2,484 oto-endoscopic images (OEIs) and classified them into one of three categories: normal, chronic otitis media (COM) with TM perforation, and otitis media with effusion (OME). Our results indicate that CNN models have significant potential for the automatic recognition of TM and ME infections, demonstrating a competitive accuracy of 95% in classifying TM and middle ear effusion (MEE) from OEIs. In addition to accuracy measurement, our approach achieves nearly perfect measures of 0.99 in terms of the average area under the receiver operating characteristics curve (AUROC). All these results indicate robust performance when recognizing TM and ME effusions in OEIs. Visualization through a class activation mapping (CAM) heatmap demonstrates that our proposed model performs prediction based on the correct region of OEIs. All these outcomes ensure the reliability of our method; hence, the study can aid otolaryngologists and primary care physicians in real-world scenarios.

Mood Disorders are Associated With Increased Risk of BPPV: A National Sample Cohort

OBJECTIVES

Few studies have reported that mood disorders increase the risk of benign paroxysmal positional vertigo (BPPV). The purpose of our study was to demonstrate whether the incidence of BPPV in those with mood disorders differs from that in a matched control group.

STUDY DESIGN

Nationwide cohort observational study.

METHODS

Korean Health Insurance Review and Assessment Service-National Patient Samples were collected from 2002 to 2013. A 1:4 matched mood disorder group (n = 59,340) and control group (n = 237,720) were selected. The crude and adjusted (cerebral stroke, ischemic heart disease, anxiety disorder, and osteoporosis histories) hazard ratios (HRs) for depression and BPPV were analyzed using a stratified Cox proportional hazard model. The results were stratified by age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia in these analyses.

RESULTS

The incidence of BPPV was significantly higher in the mood disorder group than in the control group (3.2% vs. 2.1%, P < .001). Mood disorder increased the risk of BPPV (adjusted HR = 1.31, 95% confidence interval [CI] = 1.23-1.39, P < .001). In subgroup analyses, the incidence of BPPV in all age groups and in both sexes was significantly higher in the mood disorder group than in the control group.

CONCLUSION

This population-based cohort study demonstrates that mood disorder was significantly associated with BPPV.

LEVEL OF EVIDENCE

N/A. Laryngoscope, 131:380-385, 2021.

Association Between Migraine and Benign Paroxysmal Positional Vertigo Among Adults in South Korea

Importance

Patients with migraine often experience various types of vertigo, and several studies have suggested an epidemiologic and physiologic association of migraine and vertigo with vestibule. However, few researchers have investigated the association between migraine and benign paroxysmal positional vertigo (BPPV).

Objective

To determine the incidence of BPPV in individuals with migraine in a large national population-based sample.

Design, Setting, and Participants

This cohort study obtained data from the Korean Health Insurance Review and Assessment Service covering the period January 1, 2002, through December 31, 2013. These data included personal information, health insurance claim codes, diagnostic codes, death records, socioeconomic data, and medical examination data for each individual in the database. A 1:4 matching method was used to select individuals for the migraine group (n = 40 682) and the control group (n = 162 728). Individuals who had a history of BPPV before the index date, for whom a match could not be identified, and who received a migraine diagnosis before age 20 years were excluded from the analysis. Data analysis was conducted from September 1, 2015, to December 31, 2017.

Main Outcomes and Measures

The crude and adjusted (by age, sex, income, region of residence, and medical history [hypertension, diabetes, or dyslipidemia]) hazard ratios for migraine and BPPV were analyzed using the Cox proportional hazards regression model.

Results

Of the 40 682 individuals in the migraine group, 10 381 (25.5%) were male and 30 301 (74.5%) were female. Of the 162 728 controls, 41 524 (25.5%) were male and 121 204 (74.5%) were female. The incidence of BPPV was statistically significantly higher in the migraine group than in the control group (2431 [6.0%] vs 3677 [2.3%]). Migraine increased the risk of BPPV (adjusted hazard ratio, 2.54; 95% CI, 2.41-2.68). In a subgroup analysis, the incidence of BPPV in all age groups and in both men and women was statistically significantly higher in the migraine group than in the control group. The incidence of BPPV was the highest in men younger than 40 years (adjusted hazard ratio, 4.49; 95% CI, 3.05-6.62), and the HR decreased in both men and women as age increased.

Conclusions and Relevance

Migraine appeared to be statistically significantly associated with higher incidence of BPPV; future studies are needed to determine the association between BPPV and specific factors related to migraine.

Differences in the Head Roll Test, Bow and Lean Test, and Null Plane between Persistent and Transient Geotropic Direction-Changing Positional Nystagmus

Background: Persistent geotropic direction-changing positional nystagmus (DCPN) has the characteristics of cupulopathy, but its underlying pathogenesis is not known. We investigated the relationship of the results of the head roll test, bow and lean test, and side of the null plane between persistent and transient geotropic DCPN to determine the lesion side of persistent geotropic DCPN and understand its mechanism. Methods: We enrolled 25 patients with persistent geotropic DCPN and 41 with transient geotropic DCPN. We compared the results of the head roll test, bow and lean test, and side of the null plane between the two groups. Results: The rates of bowing and leaning nystagmus were significantly higher in the persistent DCPN group. Only 16.0% of the persistent DCPN patients had stronger nystagmus in the head roll test and the null plane on the same side. The rates of the direction of bowing nystagmus in the bow and lean test and stronger nystagmus in the head roll test on the same side were also significantly lower in persistent DCPN than in transient DCPN. Conclusion: It was difficult to determine the lesion side in persistent geotropic DCPN using the direction of stronger nystagmus in the head roll test and null plane when the direction of the stronger nystagmus and null plane were opposite. Further study is needed to understand the position of the cupula according to head rotation and the anatomical position in persistent geotropic DCPN.

Differences in Antibiotic Resistance of MRSA Infections in Patients with Various Types of Otitis Media

OBJECTIVES

We investigated the epidemiological and antibiotic resistance differences in methicillin-resistant Staphylococcus aureus (MRSA) infections in patients with otitis media with effusion (OME), acute otitis media (AOM), chronic suppurative otitis media (CSOM), and chronic cholesteatomatous otitis media (CCOM).

MATERIALS AND METHODS

We conducted a retrospective study of patients with newly identified MRSA infections from January 2009 through January 2017. Overall, 3,522 patients from 10 tertiary referral hospitals were included in the study. An antibiotic sensitivity test was performed for each isolate.

RESULTS

MRSA infections in patients with CSOM and CCOM were more resistant to ciprofloxacin, clindamycin, erythromycin, gentamicin, levofloxacin, and tetracycline. Patients showed good susceptibility to rifampicin, trimethoprim/sulfamethoxazole (TMP/SMX), and vancomycin.

CONCLUSION

MRSA infections in various otitis media cases showed different resistance patterns. MRSA infections in patients with COM and CCOM were more resistant to antibiotics than those in patients with OME and AOM.

Is the modified cupulolith repositioning maneuver effective for treatment of persistent geotropic direction-changing positional nystagmus?

OBJECTIVE

Clinicians sometimes see patients with relatively persistent geotropic direction-changing positional nystagmus (DCPN) as a variant of lateral semicircular canal-benign paroxysmal positional vertigo (LSCC-BPPV). Recently, the concept of a "light cupula" in the lateral semicircular canal, exhibiting persistent geotropic DCPN, has been introduced. However, the underlying pathogenesis of light cupula is not known. We investigated the efficacy of a modified cupulopathy repositioning maneuver (mCuRM), designed to reduce light debris attached to the cupula in patients with persistent geotropic DCPN.

STUDY DESIGN

Retrospective cohort study.

METHODS

Participants included 65 patients with a persistent geotropic DCPN: 35 underwent treatment (mCuRM group), and 30 were followed-up but received no treatment (No CuRM group). We compared the therapeutic and survival rate of persistent geotropic DCPN between two groups.

RESULTS

On Day 1, the persistent geotropic DCPN did not resolve in either group. On the first and second follow-up days, persistent geotropic DCPN was observed in 28 (80%) and 21 (60%) of patients, respectively, in the mCuRM group, and in 28 (93.3%) and 24 (80%) patients, respectively, in the no mCuRM group. The differences between groups were not statistically significant. Furthermore, no between-group differences were found in the time from diagnosis to resolution of nystagmus, or the time from symptom onset to resolution of nystagmus. Kaplan-Meier analysis of the time course of persistent geotropic DCPN resolution from the day of diagnosis and day of symptom onset revealed no significant differences between the groups.

CONCLUSION

Our findings indicate that mCuRM had no therapeutic benefit for a persistent geotropic DCPN and suggest that the pathophysiology of persistent geotropic DCPN is less likely to be a light debris attached to the cupula.

Pseudo-spontaneous nystagmus in patients with geotropic direction-changing positional nystagmus

Background

Pseudo-spontaneous nystagmus has been reported in patients with direction-changing positional nystagmus (DCPN). Recently, the concept of a “light cupula” has been introduced as a pathophysiology that can exhibit persistent geotropic DCPN. Patients with persistent DCPN could have different characteristics of nystagmus. Therefore, we investigated the pseudo-spontaneous nystagmus in patients with transient (canalolithiasis) and persistent (belong to light cupula theory) geotropic DCPN.

Methods

In this study, prospectively, 49 patients with persistent geotropic DCPN and 67 patients with transient geotropic DCPN were enrolled. We compared the incidence of pseudo-spontaneous nystagmus between persistent and transient DCPN patients and characteristics of pseudo-spontaneous nystagmus and positional nystagmus by the head roll test in these patients. A prospective study was conducted at a dizziness clinic.

Results

Patients with persistent geotropic DCPN exhibited significantly higher incidence of pseudo-spontaneous nystagmus than patients with transient geotropic DCPN. Patients with transient DCPN showed a significantly higher mean SPV value during the head roll test than patients with persistent DCPN. All patients exhibiting pseudo-spontaneous nystagmus in patients with persistent DCPN had a null plane, and all patients had nystagmus beats to the opposite side of the null plane or the lesion side.

Conclusion

Our results support the possibility that the mechanism between persistent and transient geotropic DCPN may be different. However, more studies are needed on the pathogenesis and mechanism of the two diseases, including the occurrence of pseudo-spontaneous nystagmus in the disease entity.

Anti-fibrotic effects of Cuscuta chinensis with in vitro hepatic stellate cells and a thioacetamide-induced experimental rat model

CONTEXT

Cuscuta chinensis Lam. (Convolvulaceae) has been used as a traditional herbal remedy for treating liver and kidney disorders.

OBJECTIVE

Anti-fibrotic effects of C. chinensis extract (CCE) in cellular and experimental animal models were investigated.

MATERIALS AND METHODS

HSC-T6 cell viability, cell cycle and apoptosis were analysed using MTT assay, flow cytometry and Annexin V-FITC/PI staining techniques. Thioacetamide (TAA)-induced fibrosis model was established using Sprague Dawley rats (n = 10). Control, TAA, CCE 10 (TAA with CCE 10 mg/kg), CCE 100 (TAA with CCE 100 mg/kg) and silymarin (TAA with silymarin 50 mg/kg). Fibrosis was induced by TAA (200 mg/kg, i.p.) twice per week for 13 weeks. CCE and silymarin were administered orally two times per week from the 7th to 13th week. Fibrotic related gene expression (α-SMA, Col1α1 and TGF-β1) was measured by RT-PCR. Serum biomarkers, glutathione (GSH) and hydroxyproline were estimated by spectrophotometer using commercial kits.

RESULTS

CCE (0.05 and 0.1 mg/mL) and silymarin (0.05 mg/mL) treatment significantly (p < 0.01 and p < 0.001) induced apoptosis (11.56%, 17.52% for CCE; 16.50% for silymarin, respectively) in activated HSC-T6 cells, compared with control group (7.26%). Further, rat primary HSCs showed changes in morphology with CCE 0.1 mg/mL treatment. In in vivo studies, CCE (10 and 100 mg/kg) treatment ameliorated the TAA-induced altered levels of serum biomarkers, fibrotic related gene expression, GSH, hydroxyproline significantly (p < 0.05-0.001) and rescued the histopathological changes.

CONCLUSIONS

CCE can be developed as a potential agent in the treatment of hepatofibrosis.

The Light Cupula: An Emerging New Concept for Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common type of positional vertigo. A canalolithiasis-type of BPPV involving the lateral semicircular canal (LSCC) shows a characteristic direction-changing positional nystagmus (DCPN) which beats towards the lower ear (geotropic) on turning the head to either side in a supine position. Because geotropic DCPN in LSCC canalolithiasis is transient with a latency of a few seconds, the diagnosis can be challenging if geotropic DCPN is persistent without latency. The concept of “light cupula” has been introduced to explain persistent geotropic DCPN, although the mechanism behind it requires further elucidation. In this review, we describe the characteristics of the nystagmic pattern in light cupula and discuss the current evidence for possible mechanisms explaining the phenomenon.

Bacterial Species and Antibiotic Sensitivity in Korean Patients Diagnosed with Acute Otitis Media and Otitis Media with Effusion

Changes over time in pathogens and their antibiotic sensitivity resulting from the recent overuse and misuse of antibiotics in otitis media (OM) have complicated treatment. This study evaluated changes over 5 years in principal pathogens and their antibiotic sensitivity in patients in Korea diagnosed with acute OM (AOM) and OM with effusion (OME). The study population consisted of 683 patients who visited the outpatient department of otorhinolaryngology in 7 tertiary hospitals in Korea between January 2010 and May 2015 and were diagnosed with acute AOM or OME. Aural discharge or middle ear fluid were collected from patients in the operating room or outpatient department and subjected to tests of bacterial identification and antibiotic sensitivity. The overall bacteria detection rate of AOM was 62.3% and OME was 40.9%. The most frequently isolated Gram-positive bacterial species was coagulase negative Staphylococcus aureus (CNS) followed by methicillin-susceptible S. aureus (MSSA), methicillin-resistant S. aureus (MRSA), and Streptococcus pneumonia (SP), whereas the most frequently isolated Gram-negative bacterium was Pseudomonas aeruginosa (PA). Regardless of OM subtype, ≥ 80% of CNS and MRSA strains were resistant to penicillin (PC) and tetracycline (TC); isolated MRSA strains showed low sensitivity to other antibiotics, with 100% resistant to PC, TC, cefoxitin (CFT), and erythromycin (EM); and isolated PA showed low sensitivity to quinolone antibiotics, including ciprofloxacin (CIP) and levofloxacin (LFX), and to aminoglycosides. Bacterial species and antibiotic sensitivity did not change significantly over 5 years. The rate of detection of MRSA was higher in OME than in previous studies. As bacterial predominance and antibiotic sensitivity could change over time, continuous and periodic surveillance is necessary in guiding appropriate antibacterial therapy.

Prevalence of vestibular and balance disorders in children and adolescents according to age: A multi-center study

OBJECTIVES

Children differ from adults in the expression of dizziness symptoms and the causes of dizziness. In several studies, benign paroxysmal vertigo of childhood (BPVC) and vestibular migraine (VM) were seen exclusively in children with vertigo, but the age threshold used to define 'children' varies, and there are few reported studies about adolescents with dizziness. In this study, we investigated the prevalence of vestibular and balance disorders according to age category in a multi-center study (otolaryngology departments of 11 hospitals) of children and adolescents.

METHODS

Children and adolescents aged under 18 who visited the otolaryngology departments of 11 hospitals for dizziness were included. We classified the patients into three categories: preschool (up to and including 6-year-olds), school age (7- to 12-year-olds), and adolescents (13- to 18-year-olds). These patients were reviewed retrospectively based on their clinical charts.

RESULTS

In the preschool age group, BPVC was most common, followed by VM. In the school-age group, BPVC and VMs were most common, followed by psychogenic vertigo and benign paroxysmal positional vertigo (BPPV). In adolescents, VM was the most common, and Ménière's disease, cardiogenic vertigo, and BPVC, which are seen primarily in adults, were also seen in some adolescents.

CONCLUSION

In children and adolescents with dizziness, VM and BPVC were the most common diseases, and prevalence of disease by age showed differing distributions. These findings will help in diagnosing and managing children and adolescents with vertigo.

Clinical Analysis of Dizzy Patients with High Levels of Depression and Anxiety

Background and Objectives

Some patients experiencing dizziness also report psychological distress. However, the association between vestibular deficits and psychological symptoms remains controversial. Thus, the aim of this paper is to report the proportion of patients who complained of dizziness who also had high depression and anxiety indices. Also we investigated the severity of their dizziness and the distribution of the diseases underlying this symptom.

Subjects and Methods

We assessed the dizziness and psychological distress of 544 patients experiencing dizziness using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). We also reviewed the audio-vestibular symtoms of patients with high levels of depression and anxiety.

Results

The incidences of high depression and anxiety scores were 11% (60/544) and 18% (98/544), respectively. Patients with vestibular migraine were most likely to have high depression and anxiety indices. Patients in the high-BDI or high-STAI groups (117/544) obtained significantly higher DHI scores than those in neither the high-BDI nor the high-STAI group (427/544). We noticed that about 20% of the patients experiencing dizziness had high levels of psychological distress in this study; this group also suffered from various vestibular diseases and more symptoms of dizziness.

Conclusions

The results of the study suggest that psychological evaluation should be considered when assessing patients with vertigo.

Analysis of the Prevalence of and Factors Associated with Hearing Loss in Korean Adolescents

Background

Hearing loss can lead to a number of disabilities, subsequently reducing the quality of life. In general, hearing thresholds of adolescents are better than adults and the elderly. However, occasionally, adolescents acquire hearing loss for a number of reasons. In this study, our goal was to estimate the prevalence of hearing loss in the Korean population and to investigate the factors related to hearing thresholds in adolescents.

Methods

A cross-sectional study was conducted using data from the Korean National Health and Nutrition Examination Survey (KNHANES) between 2010 and 2012. We enrolled a total of 1,658 participants, ages 13 to 18 years. We investigated the prevalence of hearing loss and the factors associated with hearing thresholds at various frequencies (0.5, 1, 2, 3, 4, and 6 KHz).

Results

Weighted prevalence of unilateral and bilateral hearing loss in Korean adolescents was 2.2% and 0.4%, respectively. Weighted prevalence of hearing thresholds ≥ 20 dB at speech and high frequencies were 3.1% and 5.0%, respectively, for unilateral hearing loss and 0.7% and 1.9%, respectively, for bilateral. Age group, tympanometric data, and household income were significantly related to unilateral or bilateral hearing thresholds ≥ 20 dB at speech frequencies. Earphone use in noisy places was associated with bilateral hearing thresholds ≥ 20 dB at high frequencies.

Conclusions

The prevalence of hearing loss in Korean adolescents was 2.6% using the general standard threshold associated with hearing loss. However, the prevalence of hearing thresholds ≥ 20 dB for speech and high frequencies was much higher. The results from this study provide an estimate of hearing loss in adolescents and suggest the need for early detection and hearing preservation programs among adolescents.

NAMPT suppresses glucose deprivation-induced oxidative stress by increasing NADPH levels in breast cancer

Nicotinamide phosphoribosyltransferase (NAMPT) is a rate-limiting enzyme involved in NAD+ biosynthesis. Although NAMPT has emerged as a critical regulator of metabolic stress, the underlying mechanisms by which it regulates metabolic stress in cancer cells have not been completely elucidated. In this study, we determined that breast cancer cells expressing a high level of NAMPT were resistant to cell death induced by glucose depletion. Furthermore, NAMPT inhibition suppressed tumor growth in vivo in a xenograft model. Under glucose deprivation conditions, NAMPT inhibition was found to increase the mitochondrial reactive oxygen species (ROS) level, leading to cell death. This cell death was rescued by treatment with antioxidants or NAD+. Finally, we showed that NAMPT increased the pool of NAD+ that could be converted to NADPH through the pentose phosphate pathway and inhibited the depletion of reduced glutathione under glucose deprivation. Collectively, our results suggest a novel mechanism by which tumor cells protect themselves against glucose deprivation-induced oxidative stress by utilizing NAMPT to maintain NADPH levels.

Multi-step prediction of physiological tremor for robotics applications

The performance of surgical robotic devices in real-time mainly depends on phase-delay in sensors and filtering process. A phase delay of 16-20 ms is unavoidable in these robotics procedures due to the presence of hardware low pass filter in sensors and pre-filtering required in later stages of cancellation. To overcome this phase delay, we employ multi-step prediction with band limited multiple Fourier linear combiner (BMFLC) and Autoregressive (AR) methods. Results show that the overall accuracy is improved by 60% for tremor estimation compared to single-step prediction methods in the presence of phase delay. Experimental results with the proposed methods for 1-DOF tremor estimation highlight the improvement.

Transverse fracture of the stapes anterior crus caused by the blast pressure from a land mine explosion

Stapes fractures without other ossicle problems are rare and ossicle problems due to explosion pressure are also rare. We describe a very rare case of stapes anterior crural fracture resulting from a land mine explosion. As this case suggests, a close examination of the ossicles is necessary during an exploration tympanotomy.

Congenital cholesteatoma localized to the tip of the mastoid bone: a case report and possible etiology

Congenital cholesteatomas of mastoid origin are extremely rare. We reported one in 2007 and experienced an additional case. A male presented with a 5-month history of right-sided ear discharge. Computed tomography of the temporal bone showed a soft tissue density occupying the mastoid tip. At surgery, the cholesteatoma sac was completely isolated from the mastoid antrum and lateral air cell in the mastoid tip area. We now doubt the rarity of this entity. With a brief literature review, we consider how the cholesteatoma localizes to the tip of the mastoid bone.

Analysis of Dizzy Patients with High Depression and Anxiety Index

Objectives:

Some patients with dizziness often show psychological distress. However, the association of vestibular deficit with psychological symptoms remains controversial. Thus, we investigated the incidence of high depression and anxiety index in patients who complained of dizziness, their dizziness severity, and the distribution of disease to induce dizziness.

Methods:

In 562 patients with dizziness, dizziness and the psychological distress of all patients were measured using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). We examined the incidence of patients having high depression and anxiety using a cutoff value (BDI ≥21, STAI ≥57). We divided patients into a high psychological distress index group and a moderate to low index group on the basis of cut-off value and compared the type of disease and DHI score between the 2 groups.

Results:

The incidence of high BDI and STAI scores were 11% and 13.5%, respectively. The high BDI and STAI group showed the higher DHI scores, including functional, emotional and physical subscales, and the higher STAI and BDI scores, respectively. The mean age, sex and the distribution of the type of disease between high psychological distress index group and moderate to low index group showed no difference.

Conclusions:

Of patients with dizziness, about one-tenth have serious psychological distress, various vestibular diseases, and more dizzy symptoms. Thus, we should keep in mind the psychological factor in dizzy patients and the necessity of psychological support in the patients.

Effect of bacteriophage supplementation on the growth performance, nutrient digestibility, blood characteristics, and fecal microbial shedding in growing pigs

A total of 144 ((Duroc×Yorkshire)×Landrace)) pigs with an average initial BW of 28.85±0.63 kg were used in this 6-wk growth trial. Pigs were randomly allotted to 1 of 4 treatments in a completely random block design. Each dietary treatment consisted of 9 replicate pens, with 4 pigs per replicate. Dietary treatments included: i) NC (basal diet), ii) PC (NC+apramycin 0.5 g/kg), iii) BPT1 (NC+bacteriophage 0.25 g/kg) and iv) BPT2 (NC+bacteriophage 0.5 g/kg). The inclusion of antibiotics and bacteriophages did not affect the (p>0.05) ADG, ADFI and G:F compared with the basal diet. Dietary antibiotics and bacteriophages supplementation led to a higher (p<0.05) DM digestibility than the NC treatment. Pigs fed the bacteriophage supplemented diet increased (p<0.05) the N digestibility compared with those fed NC treatment. Supplementation of antibiotics led to a higher (p<0.05) energy digestibility than the NC treatment. No difference (p>0.05) was observed in the RBC, WBC, lymphocyte concentration and fecal moisture among treatments. Pigs fed PC and BPT2 treatments reduced (p<0.05) the E. coli concentration compared with those fed NC treatment. The inclusion of BPT2 treatment led to a higher (p<0.05) lactobacillus concentration compared with NC and PC treatment. Dietary antibiotic and bacteriophage supplementation reduced (p<0.05) the Salmonella concentration compared with NC treatment. In conclusion, our study suggested that bacteriophage at the level of 0.5 g/kg could be used as an antibiotics alternative for growing pigs.

Effect of Medium-chain Triglyceride (MCT) on Growth Performance, Nutrient Digestibility, Blood Characteristics in Weanling Pigs

One hundred and twenty weanling pigs in experiment 1 (Exp. 1) (6.91±0.99 kg; 21 d of age) and Exp. 2 (10.20±1.09 kg; 28 d of age) were used in two 42-d and 35-d experiments to evaluate the effect of medium-chain-triglyceride (MCT) on growth performance, apparent total tract digestibility (ATTD) of nutrients and blood profile. In both of Exp. 1 and Exp. 2, the same dietary treatments were utilized as follows : i) negative control (NC), ii) positive control (PC), NC+antibiotics (40 mg/kg Tiamulin, 110 mg/kg Tylosin, and 10 mg/kg Enramycin, iii) MCT3, NC+0.32% (phase 1, 2 and 3) MCT, and iv) MCT5, NC+0.55% (phase 1), 0.32% (phase 2 and 3) MCT. In Exp. 1, the pigs fed MCT5 diets had higher (p<0.05) ADG compared to NC treatment during the first 2 wk. From d 15 to 28, the ATTD of energy was improved (p<0.05) by MCT3 compared to the PC treatment. No effect has been observed on the blood profiles [red blood cell (RBC), white blood cell (WBC), immunoglobulin-G (IgG), lymphocyte concentration] measured in this study. In Exp. 2, the ADG were increased (p<0.05) by the MCT5 treatment than the PC treatment from d 0 to 14. Pigs fed PC treatment diet had lower ADFI (p<0.05) and better FCR (p<0.05) than NC treatment, whereas no differences were shown between MCT treatments and NC or PC treatment from d 15 to 35 and overall phase. The ATTD of DM and nitrogen were improved (p<0.05) by the effect of MCT5 related to the NC and PC treatment at the end of 2nd and 5th wk. The pigs fed MCT3 had higher (p<0.05) energy digestibility than PC treatment. No effects were seen in the blood profiles we measured (WBC, RBC, lymphocyte and immunoglobulin-G). In conclusion, the addition of MCT in the weanling pigs diet can improve the ADG and digestibility during the earlier period (first 2 wks), but had little effect on the blood characteristics.

Evaluation of the effect of low dietary fermentable carbohydrate content on growth performance, nutrient digestibility, blood characteristics, and meat quality in finishing pigs

A total of 96 pigs (49.23±3.20 kg) were used in an 11 wk growth trial to evaluate the effect of fermentable carbohydrate (FC) content on growth performance, apparent total tract digestibility (ATTD) of nutrient, blood profile, and meat quality. The dietary treatments were: i) negative control (NC), basal diet, ii) positive control (PC), NC+antibiotics (positive control diet with 5 ppm flavomycin), iii) PCL, PC-13% lower FC, and iv) NCL, NC-13% lower FC. The growth performance (average daily gain, average daily feed intake, and gain/feed) didn’t differ among treatments through the whole experiment. These pigs fed the PCL diet had the greater (p<0.05) apparent total tract digestibility (ATTD) of dry matter than those from PC and NC treatment at the end of the experiment. No differences were observed in white blood cell (WBC), red blood cell (RBC), and lymphocyte concentration among different treatments. After the feeding period, meat samples were collected from the pigs at slaughter. The pigs in NCL and PCL treatments had greater (p<0.05) backfat thickness and lower lean percentage. The color value of loin was higher (p<0.05) in NCL treatment compared to PCL treatment. Also, the NCL treatment had higher (p<0.05) marbling value than PC treatment. The drip loss was depressed by PCL and NCL treatment comapared to NC treatments. The water holding capacity (WHC) was higher (p<0.05) in NC and PCL treatment. In conclusion, the low FC can improve digestibility and meat quality of finishing pigs.

Unusual presentation of a metastatic tumor to the temporal bone: severe otalgia and facial paralysis

Metastatic temporal bone tumors are rare diseases and they are usually clinically asymptomatic, so it is difficult to diagnose them. Breasts are the most common sites of temporal bone metastasis. Tumors of lung, kidney, gastrointestinal tract, prostate gland, larynx and thyroid gland are the other sites. The pathogenesis of the temporal bone is most commonly related to the hematogenous route. We present the case of a 78-year-old man with facial paralysis combined with severe otalgia. This patient was initially diagnosed with Bell's palsy. However, based on the radiologic findings, the patient was diagnosed with lung cancer with temporal bone metastasis.

Clinical analysis of patients with idiopathic sudden sensorineural hearing loss and benign paroxysmal positional vertigo

CONCLUSIONS

Thirteen (5.4%) of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) had benign paroxysmal positional vertigo (BPPV). Most of the patients showed profound hearing loss and had BPPV of the lateral canal. BPPV in patients with ISSNHL may have no influence on hearing recovery.

OBJECTIVES

BPPV occurs in 8.6-12.7% of patients with ISSNHL; however, the role of BPPV in hearing recovery remains controversial. Therefore, we investigated hearing outcomes in the patients, including the distribution of initial hearing threshold, the type of canal involved, and the number of repositioning maneuvers performed.

METHODS

Of 241 patients with ISSNHL who presented to a dizziness clinic between March 2008 and May 2012, 13 with both ISSNHL and BPPV were recruited for this study. The patients were evaluated for their initial hearing threshold, type of canal involved, response to repositioning maneuvers, and hearing outcome. Age- and hearing threshold-matched patients with ISSNHL but without BPPV were randomly sampled and included for a hearing outcome comparison.

RESULTS

Of 13 patients with ISSNHL and BPPV, 11 showed profound hearing loss. The lateral canal was involved in 11 patients, including 3 who had multi-canal involvement. Ten patients underwent a single repositioning maneuver. Those patients did not display a significant difference in hearing recovery compared with those patients having ISSNHL only.

Comparison of temporal bone fractures in children and adults

CONCLUSION

Contrary to our expectation, that the clinical characteristics of temporal bone fracture would differ in children and adults, we found that the two groups were similar.

OBJECTIVES

Most studies of temporal bone fractures have been performed in adults. To our knowledge, no study has investigated differences in temporal bone fractures in children and adults. We therefore investigated differences in temporal bone fractures in adults and children by examining the manifestations and clinical symptoms of temporal bone fractures in pediatric patients.

METHODS

The demographic and clinical characteristics were assessed in 32 children and 186 adults with temporal bone fractures. All patients underwent computed tomography of the temporal bone.

RESULTS

Causes of fracture, gender distribution, manifestations of temporal bone fracture, and clinical symptoms were similar in adults and children (p > 0.05 each). Petrous fracture, ear fullness, dizziness, and tinnitus were significantly more frequent in adults than in children (p < 0.05 each).

Influence of Vestibular Disease on Psychological Distress

Objectives

Some patients with dizziness show high comorbidity with psychiatric disorders. However, the association of vestibular deficit with psychological symptoms remains controversial. Thus, we investigated psychological distress (depression and anxiety) in patients with vestibular disease and examined factors modifying the development of psychological distress in these patients, including age, sex, severity of dizziness symptoms, and type of vestibular disease.

Study Design

Prospective study.

Setting

Tertiary referral center.

Subjects and Methods

This study enrolled 407 patients with dizziness. Dizziness and the psychological symptoms of all patients were measured using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). We evaluated the influence of vestibular disease type, DHI score, and other factors such as sex and age on the psychological scales (BDI, STAI) through multiple regression analysis.

Results

Only DHI score and vestibular neuritis were related significantly to BDI scores in patients with vestibular disease, and only DHI scores were associated with STAI scores.

Conclusion

Dizziness Handicap Inventory scores and psychological distress were closely associated. Psychological distress might be a consequence of high DHI score rather than of a specific type of vestibular disease, although depressive symptoms were related to vestibular neuritis.

Open reduction of nasal bone fractures through an intercartilaginous incision

CONCLUSION

Open reduction through an intercartilaginous incision was useful for treating delayed-diagnosed nasal bone fractures because it resulted in a successful outcome with minimal complications.

OBJECTIVES

Nasal bone fractures are generally managed with closed reduction, which is usually inadequate and results in airway obstruction with a delayed diagnosis of nasal bone fracture when bone healing and fibrotic adhesions around the bone fragment have progressed. This study investigated the surgical outcome of open reduction through an intercartilaginous incision for delayed-diagnosis nasal bone fractures.

METHODS

The study enrolled 18 patients who underwent open reduction through an intercartilaginous incision to correct delayed-diagnosis nasal bone fractures. Three independent otorhinolaryngologists evaluated the outcomes 4-35 months (average 12.7 months) postoperatively as excellent, fair or poor.

RESULTS

The time from injury to surgery was 11-39 days (20-39 days in adults and 11-30 days in children). The 18 cases included 16 primary repairs and two revisions. A Kirschner wire was inserted in six (33.3%) patients who had unstable reduced nasal bones. Postoperatively, l5 (83%) patients had excellent results, two (11%) had fair, and one (6%) had a poor outcome. No patient experienced any complication.

The effectiveness of 1-point fixation for zygomaticomaxillary complex fractures

OBJECTIVES

To introduce the surgical technique of 1-point fixation at the zygomaticomaxillary buttress (ZMB) and to verify its effectiveness using 3-dimensional computed tomography (3D CT).

DESIGN

Case series with chart review.

SETTING

Academic tertiary care medical center.

PATIENTS AND METHODS

The study included 29 patients who underwent 1-point fixation at the ZMB for zygomaticomaxillary complex fractures without comminution of lateral orbital rim fractures. Preoperative and postoperative 3D CT scans were obtained to evaluate vertical and horizontal changes of the zygoma, which were were analyzed according to preoperative 3D CT findings.

RESULTS

The ZMB area was fixed with a resorbable system in 26 patients and with a metal system in 3 patients. After surgery, the mean vertical change improved from 1.28° to 0.58° (P < .001), and the mean horizontal change improved from 1.71° to 0.92° (P < .001). Postoperative vertical movement of the zygoma was not significantly affected by comminution of the inferior orbital wall, zygomaticofrontal process displacement, or comminution of the ZMB area and zygomatic arch (P > .05 for each). However, comminution of the ZMB area had an adverse effect on horizontal movement of the zygoma (P = .03). Complications after surgery included facial cellulitis associated with acute sinusitis in 1 patient, who was treated successfully. No patient required revision reduction because of facial deformity.

CONCLUSION

Our findings suggest that 1-point fixation at the ZMB provides sufficient stability of the zygomaticomaxillary complex without comminuted fractures of the lateral orbital rim.

The evaluation of soybean meals from 3 major soybean-producing countries on productive performance and feeding value of pig diets

This study was conducted to evaluate 1) the effects of soybean meal (SBM) from 3 major SBM-producing countries (United States, Brazil, and India) on the growth performance, nutrient digestibility, and meat quality of growing-finishing pigs and 2) the feeding value of the evaluated SBM as a feedstuff for growing-finishing pigs. Soybean meal representative of each country was purchased on the open market. A total of 144 barrows with the average BW of 23.77 (SD = 1.52 kg) were allotted to 3 dietary treatments with 12 replicate pens per treatment and 4 pigs per pen. The US SBM used in this trial had greater CP and total AA contents, greater KOH protein solubility, and less crude fiber than SBM from either Brazil or India. Diets were formulated to be isolysinic and isocaloric. Pigs fed diets containing US SBM were heavier (P < 0.05) than pigs fed diets containing Brazilian or Indian SBM at 12 and 18 wk. Pigs fed diets containing US SBM had greater (P < 0.05) ADG and G:F throughout the overall period when compared with pigs fed SBM produced in Brazil or India. The DM and N digestibility were greater for US SBM (P < 0.05) than Brazilian and India SBM at 6, 12, and 18 wk. Pigs were slaughtered at the end of 18 wk, and no differences were observed on meat quality (backfat thickness, LM area, pH, meat color, water holding capacity, and drip loss) among the treatments, except lean percentages were less and backfat thickness was greater in pigs fed Brazilian and Indian SBM than US SBM. The cost per kilogram of BW gain of the experimental diet containing US SBM was less than that of diets containing Brazilian or Indian SBM, but it would depend on the relative prices of each SBM. Based on the results of the current experiment, the productivity and feeding value of US SBM seems to be greater than the SBM produced in Brazil and India.

A balloon dilatation technique for the treatment of intramaxillary lesions using a Foley catheter in chronic maxillary sinusitis

BACKGROUND

In chronic maxillary sinusitis, pathologic mucosas of the anterior and lateral walls of the maxillary sinus are difficult to remove. Trocar insertion to the canine fossa is the most commonly used procedure. In the present work, we report a method involving a balloon dilatation technique for treatment of intramaxillary lesions using a Foley catheter in chronic maxillary sinusitis and the outcomes of this approach.

METHODS

Records of 34 patients with intramaxillary sinus lesions who underwent endoscopic sinus surgery were analyzed. After widening the natural ostium, a 10F Foley catheter was inserted through the widening ostium into the maxillary sinus. The intramaxillary lesion was removed by repeated balloon inflation and deflation of the Foley catheter. The patients were followed-up for at least 6 months after the surgery.

RESULTS

There were no significant intraoperative or postoperative complications. We found that the postoperative symptoms and resolution of the lesions in comparison to classic functional endoscopic sinus surgery were not different in authors' experiences.

CONCLUSION

The balloon dilatation technique using a Foley catheter is a minimally invasive and effective technique that is not associated with major complications in cases of intramaxillary lesions.

Resorbable skeletal fixation systems for treating maxillofacial bone fractures

OBJECTIVE

To evaluate the effectiveness of using resorbable plate and screw systems (RPSSs) compared with metal plate and screw systems (MPSSs) to treat maxillofacial bone fractures.

DESIGN

Retrospective study.

SETTING

Chuncheon Sacred Heart Hospital, Chuncheon, South Korea.

PATIENTS

Eighty-two patients diagnosed as having zygomaticomaxillary fractures between February 1, 2004, and December 31, 2008.

INTERVENTION

We used RPSSs in 56 patients and MPSSs in 26 patients.

MAIN OUTCOME MEASURE

Complication rates.

RESULTS

The 82 patients included 72 males and 10 females aged 16 to 83 years. Follow-up ranged from 3 to 12 months. The complication rate was 7% (4 of 56) with RPSSs and 4% (1 of 26) with MPSSs. Using RPSSs, 2 patients experienced device exposure and 1 accompanying infection. With device exposure, the plates were removed. One patient noted paresthesia in the premaxillary area. Using MPSSs, 1 patient had a loosened metal screw; the other patients had no problems.

CONCLUSIONS

Based on the present experience, there are many advantages to RPSSs. Nevertheless, we should select the fixation system carefully depending on the fracture site and whether there is accompanying infection. It is important to select the method that best fits the patient's situation.

Vestibular-Evoked Myogenic Potentials in Migrainous Vertigo

Objective. Patients with migraine headaches have a high prevalence of episodic vertigo, and several studies support the clinical association of migraine and vertigo. Various tests have been conducted in patients with migrainous vertigo; however, only a few studies have been reported on otolith function. The aim of the present study was to increase the understanding of migrainous vertigo pathophysiology by assessing the sacculocollic pathway in patients with migrainous vertigo using vestibular-evoked myogenic potentials testing (VEMPs).

Study Design. Prospective study.

Setting. Tertiary referral center.

Subjects and Methods. VEMP testing was performed in 30 patients with migrainous vertigo and 31 healthy volunteers using 90- and 100-dB tone-pip stimuli. We compared hearing, p13 and n23 latency, VEMP asymmetry, and VEMP formation rate between the patient and control groups.

Results. No between-group difference was observed in p13 and n23 latency or VEMP asymmetry. The rate of normal VEMP wave formation in both ears was significantly lower in the patient group compared with that of the control group in response to the 90-dB stimulus. Furthermore, VEMP wave formation was absent in both ears at 100 dB in significantly more patients than in control subjects.

Conclusion. The results indicate that patients with migrainous vertigo show abnormal VEMP findings, suggesting that migrainous vertigo might have a lesion at the sacculocollic pathway.

Extensive external auditory canal cholesteatoma in the infratemporal area without mastoid involvement: use of a new surgical technique

The external auditory canal (EAC) is an unusual location for a cholesteatoma. We present the cases of 2 patients with EAC cholesteatoma who experienced extensive damage that extended from the inferior EAC wall to the infratemporal area; there was no mastoid involvement. In both cases, the cholesteatomas were removed under local anesthesia and the inferior canal wall was reconstructed with a technique that involved the placement of a pedicled musculoperiosteal flap, a cartilage graft, and a full-thickness skin graft. This simple procedure preserves a normal EAC contour, middle ear space, and mastoid cavity.