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Song IG, Kim YS, Kim MS, Lee JW, Cho YM, Lim Y, Kwon SK, Suh DI, Park JD. Healthcare service use and medical outcomes of tracheostomy-dependent children: a nationwide study. BMJ Paediatr Open 2024; 8:e002377. [PMID: 38508660 PMCID: PMC10952918 DOI: 10.1136/bmjpo-2023-002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Despite the rising trend of tracheostomies in children, there is a lack of comprehensive resources for families to navigate the challenges of living with a tracheostomy, emphasising the need for evidence-based support in understanding postoperative care and long-term adjustments. This study aimed to examine the pattern of using healthcare services and nationwide medical outcomes in children who underwent a tracheotomy before the age of 2 years. METHODS This retrospective study used the National Health Insurance System database from 2008 to 2016 and included all children codified with tracheotomy procedure codes before their second birthday. Healthcare utilisation, such as medical costs, number of hospital visits, home healthcare nursing and medical diagnoses on readmission, in the first 2 years after tracheotomy was evaluated. Multivariable logistic regression analysis was used to determine the factors affecting mortality. RESULTS In total, 813 patients were included in this study. Their use of healthcare services and the accompanying expenses were higher than the national medians for similar age groups; however, both metrics decreased in the second year. The major causes of admission within 2 years of surgery were respiratory and neurological diseases. The mortality rate within 2 years was 37.8%. Higher risks of mortality were associated with having two or more complex chronic conditions. Use of home healthcare nursing services was associated with a lower mortality risk. CONCLUSION Paediatric patients with more complex chronic conditions tended to have higher mortality rates within 2 years after surgery. However, receiving home healthcare nursing was significantly associated with a reduced risk of death. Many causes of hospitalisation may be preventable with education and supportive care. Therefore, further research for establishing an integrated care system for these patients and their caregivers is required.
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Affiliation(s)
- In Gyu Song
- Pediatrics, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - You Sun Kim
- Department of Paediatrics, National Medical Center, Jung, Korea (the Republic of)
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Min Sun Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Seoul National University Children's Hospital Integrated Care Center, Seoul, Korea (the Republic of)
| | - Ji Weon Lee
- Seoul National University Children's Hospital Integrated Care Center, Seoul, Korea (the Republic of)
| | - Yoon-Min Cho
- National Health Insurance Service, Wonju, Korea (the Republic of)
| | - Youna Lim
- Seoul National University, Gwanak-gu, Korea (the Republic of)
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Dong In Suh
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - June Dong Park
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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Kwon SK, Park SJ, Chung EJ, Sohn JH, Sun DI, Jin SM, Lee BJ, Park IS, Cho JG, Park YH. Predictors of Early and Late Response to Esomezol and Lifestyle Modification in Adults With Laryngopharyngeal Reflux Disease: A Prospective, Multicenter, Open-Label Cohort Study. Clin Exp Otorhinolaryngol 2023; 16:259-274. [PMID: 37350172 PMCID: PMC10471909 DOI: 10.21053/ceo.2023.00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/31/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES This study aimed to assess predictors of the response to varying durations of proton pump inhibitor (PPI) use and lifestyle modification treatment for laryngopharyngeal reflux disease (LPRD). METHODS Between October 2014 and June 2016, a prospective, multicenter, open-label, single-cohort, intention-to-treat, observational study was conducted at eight referral hospitals across the Republic of Korea to examine predictors of early and late response to treatment in adult patients (age ≥19 years) with LPRD. Participants underwent standard treatment (PPI [Esomezol] and lifestyle modification) for 3 months. Response to treatment was defined as greater than 50% improvement in reflux symptom index score. The primary outcome was potential predictors of treatment response at 1 and 3 months. The secondary outcome was potential predictors distinguishing early from late responders. RESULTS In total, 394 patients were enrolled. Improved sleep habits was a positive predictor (odds ratio [OR], 1.785; 95% confidence interval [CI], 1.06-3.007; P=0.029), while initial alcohol consumption (OR, 0.587; 95% CI, 0.355-0.969; P=0.037) and past medication history (OR, 0.438; 95% CI, 0.215-0.891; P=0.005) were negative predictors of response after 1 month of treatment. High pre-reflux finding score was a positive predictor (OR, 1.187; 95% CI, 1.049- 1.344; P=0.007), while male sex (OR, 0.516; 95% CI, 0.269-0.987; P=0.046), higher depression score (OR, 0.867; 95% CI, 0.784-0.958; P=0.005), and past thyroid hormone medication history (OR, 0.161; 95% CI, 0.033-0.788; P=0.024) were negative predictors of response after 3 months of treatment. Past medication history (OR, 0.438; 95% CI, 0.215-0.891; P=0.023) was the only negative predictor for early responders compared to late responders. CONCLUSION Adult patients with LPRD and a history of prior medication use may require longer treatment durations to achieve a therapeutic response. Future research should explore the incorporation of diverse treatment approaches to improve treatment outcomes for patients exhibiting negative prognostic indicators.
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Affiliation(s)
- Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Ho Sohn
- Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong-Il Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Min Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Hak Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Han SH, Kim M, Ji JY, Kwon SK. Analysis of clinical features and risk factors of subglottic cysts in children: a clinical experience using the spontaneous respiration technique. Clin Exp Otorhinolaryngol 2023; 16:177-183. [PMID: 36822198 DOI: 10.21053/ceo.2023.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/17/2023] [Indexed: 02/19/2023] Open
Abstract
Objective Subglottic cyst (SGC) is one of the rare causes of respiratory distress caused by upper airway obstruction in infants and young children. Risk factors other than prematurity with a history of endotracheal intubation have not yet been well elucidated. Therefore, we aimed to describe the clinical features and analyze the risk factors of SGC. Methods A retrospective review of medical records of pediatric patients who underwent marsupialization for SGCs between January 2017 and March 2022 was undertaken. These records were then compared with those of controls with a history of neonatal intubation with a case to control ratio of 1:3. Results Eleven patients (8 males and 3 females) diagnosed with SGCs and 33 control patients (26 males and 7 females) were included. All patients had a history of premature birth and neonatal intubation. Symptoms of SGC appeared at a mean age of 8.2 months (1-14 months) after extubation. The mean duration of intubation was 21.5 days (2-90 days), and the intubation period was longer in patients with SGC than in controls (21.5±24.8 days vs. 5.3±7.1 days; p<0.001). Furthermore, gestational age (28.3±4.2 weeks vs. 33.8±4.4 weeks; p=0.001) and birth weight (1134.1±515.1 g vs. 2178.2±910.1 g; p=0.001) were significantly lower in patients with SGC than in controls. In multivariable analysis, intubation period was identified as an independent risk factor. Conclusion This study showed that gestational age, birth weight, and intubation period were significantly associated with development of SGC. Pediatric patients presenting with progressive dyspnea with the corresponding risk factors should undergo early laryngoscopy for the differential diagnosis of SGC.
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Affiliation(s)
- Seung Hoon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea, Hwaseong, Korea
| | - Minju Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
| | - Jeong-Yeon Ji
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
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Kim DW, Kim JK, Huh G, Lee DY, Kwon SK. Tongue Reduction Surgery Improves Mandibular Prognathism in Beckwith-Wiedemann Syndrome Without Compromising Tongue Function. Clin Exp Otorhinolaryngol 2023; 16:67-74. [PMID: 36330707 PMCID: PMC9985990 DOI: 10.21053/ceo.2022.00976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/16/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study evaluated the surgical outcomes of patients with Beckwith-Wiedemann syndrome who underwent tongue-reduction surgery and analyzed whether the malocclusion and mandibular prognathism caused by macroglossia could be improved. METHODS A retrospective medical record review was performed for 11 patients with Beckwith-Wiedemann syndrome whose macroglossia was surgically treated. Demographic data, symptoms and signs, and intraoperative and postoperative surgical outcomes were evaluated. Surgery was performed by a single surgeon using the "keyhole" technique, involving midline elliptical excision and anterior wedge resection. Preoperative and postoperative plain skull lateral X-rays were evaluated to assess prognathism improvement. RESULTS The median age at the time of surgery was 35.09 months, and the ratio of males to females was 4:7. The median surgical time was 98±31.45 minutes, and the median duration of the postoperative intensive care unit stay was 3.81±2.4 days. There were no airway complications. Two patients (18.2%) had postoperative wound dehiscence; however, there was no nerve damage, recurrence, or other complications. Among the five patients who underwent postoperative speech evaluation, all showed normal speech development, except one patient who had brain dysfunction and developmental delay. Measurements of the A point-nasion-B point (ANB) angles and sella-nasion-B point (SNB) angles (point A is the most concave point of the anterior maxilla; point B is the most concave point on the mandibular symphysis) on plain X-rays showed a significant decrease in the postoperative SNB angle (P <0.001) and a significant increase in the ANB angle (P <0.011). CONCLUSION Tongue-reduction surgery is an effective and safe technique for severe forms of macroglossia associated with Beckwith-Wiedemann syndrome. In addition, it improves mandibular prognathism in young Beckwith-Wiedemann syndrome patients with macroglossia.
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Affiliation(s)
- Do Won Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jeong Kyou Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Interdisciplinary Program in Stem Cell Biology, Seoul National University, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
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Kim IG, Wu Y, Park SA, Choi JS, Kwon SK, Choi SH, Jung KC, Shin JW, Chung EJ. Assessment of Esophageal Reconstruction via Bioreactor Cultivation of a Synthetic Scaffold in a Canine Model. Clin Exp Otorhinolaryngol 2023; 16:165-176. [PMID: 36652920 DOI: 10.21053/ceo.2022.01522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/18/2023] [Indexed: 01/19/2023] Open
Abstract
Objectives The use of tissue-engineered materials for esophageal reconstruction is a technically challenging task in animal and requires bioreactor training for enhancing cellular reactivity. Recently, there have been many attempts at esophageal tissue engineering, but the success rate has been limited due to difficulty in initial epithelialization in the special environment of peristalsis. The purpose of this study was to evaluate the potential of an artificial esophagus that can enhance the regeneration of esophageal mucosa and muscle through the optimal combination of a double-layered polymeric scaffold and a custom-designed MSC-based bioreactor system in canine model. Methods We fabricated a novel double-layered scaffold as a tissue-engineered esophagus using an electrospinning technique. Prior to transplantation, human-derived mesenchymal stem cells were seeded into the lumen of the scaffold, and bioreactor cultivation was performed to enhance cellular reactivity. After 3 days of cultivation using a bioreactor system, tissue-engineered artificial esophagus was transplanted into a partial esophageal defect (5 x 3 cm-long resection) in a canine model. Results From the SEM analysis, electrospun fibers in a tubular scaffold were found to be randomly and circumferentially oriented toword the inner and outer surfaces, respectively. Complete recovery of the esophageal mucosa was confirmed by endoscopic analysis and SEM. Esophagogastroduodenoscopy (EGD) and CT analysis also showed that there were no signs of leakage or stricture and that there were normal lumen with complete epithelialization. Significant regeneration of the mucosal layer was observed by keratin 5 immunostaining. From the α-SMA immunostaining, esophageal muscle regeneration was significantly increased in the graft (12 months) group compared with the graft (6 months) group. Conclusion A custom-designed bioreactor cultured electrospun PU scaffolds can be a promising approach for esophageal tissue engineering.
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Affiliation(s)
- In Gul Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Yanru Wu
- Department of Biomedical Engineering, Inje University, Gimhae, Gyeongnam, Korea
| | - Su A Park
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Daejeon, Korea
| | - Ji Suk Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University, College of Medicine, Seoul, Korea
| | - Kyeong Cheon Jung
- Department of Pathology, Seoul National University, College of Medicine, Seoul, Korea
| | - Jung-Woog Shin
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Daejeon, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
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Yoo B, Lee B, Park JD, Kwon SK, Kwak JG. Prevention of Tracheo-Innominate Artery Fistula Formation as a Complication of Tracheostomy: Two Case Reports. Children (Basel) 2022; 9:children9111603. [PMID: 36360331 PMCID: PMC9688328 DOI: 10.3390/children9111603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/08/2022] [Accepted: 10/21/2022] [Indexed: 01/25/2023]
Abstract
Tracheo-innominate artery fistula (TIF) is a rare complication of tracheostomy and refers to the formation of a fistula between the trachea and innominate artery. Because TIF is fatal, prevention rather than treatment is very important. Here we report the cases of two high-risk patients who underwent tracheostomy, and in whose cases attempts were made to lower the risk of TIF. In the first patient who developed a chest deformity with Duchenne muscular dystrophy, a tracheostomy was performed with a high-level (cricothyroid level) approach compared with the standard tracheostomy. In the second patient, the thoracic cage was relatively small due to a giant omphalocele, and the risk of a fistula forming was decreased by wrapping the innominate artery with an opened polytetrafluoroethylene vascular graft after resolving crowding of the intrathoracic cavity by total thymectomy. There was no TIF occurrence at the outpatient follow-up in either case. We expect that our approaches may be effective intervention measures for preventing TIF.
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Affiliation(s)
- Byungsun Yoo
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Bongjin Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-2072-3568
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul 03080, Korea
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Lee DY, Hah JH, Jeong WJ, Chung EJ, Kwon TK, Ahn SH, Sung MW, Kwon SK. Expression of defensin-associated gene can be correlated with lymph node metastasis of early stage tongue cancer. Clin Exp Otorhinolaryngol 2022; 15:372-379. [DOI: 10.21053/ceo.2022.00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/17/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: We aimed to assess the genetic differences between positive and negative lymph node metastasis in early stage tongue cancer.METHODS: A total of 35 cases of tongue cancer with RNAseq data were enrolled in this study. The gene expression profile of the following two groups was compared: 1) N0 group, T stage 1 or 2 with N0 stage; 2) N+ group, T stage 1 or 2 with N+ stage. Using the R and limma packages in the Bioconductor program, we extracted the differentially expressed genes (DEGs). Gene ontology and pathway enrichment analysis were performed using the DAVID online tool. Immune cell infiltration was analyzed using the CIBERSORT online program. Immunochemical staining of the cancer tissue was evaluated and the Cancer Genome Atlas (TCGA) data were analyzed to validate of the identified DEGs. RESULTS: There were no significant differences in infiltration of the 22 types of immune cells. Among a total of 51 DEGs identified, 14 genes were significantly upregulated while 37 genes were significantly downregulated (p<0.01; fold-change >2). Pathway analysis revealed that arachidonic acid metabolism-related pathway, calcium, and muscle contraction pathway were significantly correlated. Among DEGs, following genes were the most significantly different between two groups; DEFB4A, SPRR2B, DEFB103B, SPRR2G, DEFB4B, and FAM25A. Via TCGA data, DEFB4A and DEFB103B were more highly expressed in the N0 group than in the N+ group, although the difference did not achieve statistical significance. Immunochemical staining of cancer tissue revealed the significantly higher expression of defensin in the N0 group.CONCLUSIONS: Defensin (DEFB4A, DEFB103B, DEFB4B) may be a novel biomarker for early regional metastasis in T1/2 tongue cancer.
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Lee TH, Lee JH, Kwon SK, Chung EJ, Wu HG. Hypofractionated radiotherapy for early stage glottic cancer: efficacy of 3.5 Gy per fraction. Radiat Oncol J 2022; 40:120-126. [PMID: 35796115 PMCID: PMC9262701 DOI: 10.3857/roj.2021.01025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/11/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the treatment outcomes and toxicity profile of patients with early glottic cancer who underwent hypofractionated radiation therapy (RT) with 3.5 Gy per fraction. Materials and Methods A retrospective review was performed of the medical records of 35 patients with early stage (T1-2N0M0) glottic cancer who underwent definitive RT. The dose fractionation scheme was 59.5 Gy in 17 fractions. Posterior commissure was excluded from the clinical target volume (CTV) for 26 patients (74.3%) without glottic lesions close to this region. Results With a median follow-up of 16.23 months (range, 6.82 to 67.15 months), no local, regional, or distant recurrence was reported. Acute hoarseness (65.7%), mucositis (68.6%), radiation dermatitis (60.0%) was frequent. One patient (2.9%) reported grade 3 acute toxicity (mucositis) and there was no grade 4–5 acute toxicity. There was no grade ≥3 late toxicities; however, grade 1 late intermittent hoarseness was frequent (45.7%). The receiver operative characteristic analysis revealed that mean hypopharyngeal dose was predictive for acute grade ≥2 mucositis (area under the curve=0.9314; 95% confidence interval, 0.8524–1). The optimal threshold of mean hypopharyngeal dose for occurrence of acute grade ≥2 mucositis was 26.31 Gy, with a specificity and sensitivity of 83.3% and 88.2%, respectively. Conclusion Hypofractionated RT with fraction size of 3.5 Gy for early glottic cancer is effective. The hypopharyngeal mean dose could predict the occurrence of grade ≥2 acute mucositis. The posterior commissure can be safely excluded from the CTV.
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Affiliation(s)
- Tae Hoon Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
- Correspondence: Hong-Gyun Wu Department of Radiation Oncology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-3177 E-mail:
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Kim M, Park H, Kwon SK. Case of impacted subglottic metallic foreign body removal without tracheostomy through an endotracheal tube. Clin Case Rep 2022; 10:e05770. [PMID: 35521046 PMCID: PMC9066741 DOI: 10.1002/ccr3.5770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022] Open
Abstract
A foreign body in the upper airway can cause serious morbidity and mortality, especially in pediatric patients. This case report describes an innovative way to remove an impacted foreign body distal to the vocal folds through an endotracheal tube without tracheostomy.
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Affiliation(s)
- Minju Kim
- Department of Otorhinolaryngology - Head and Neck Surgery Seoul National University Hospital Seoul National University College of Medicine Seoul Korea
| | - Haechan Park
- Department of Otorhinolaryngology - Head and Neck Surgery Seoul National University Hospital Seoul National University College of Medicine Seoul Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology - Head and Neck Surgery Seoul National University Hospital Seoul National University College of Medicine Seoul Korea
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Lee DY, Choi YH, Choi JS, Eom MR, Kwon SK. Injection laryngoplasty of human adipose-derived stem cell spheroids with hyaluronic acid-based hydrogel improves the morphological and functional characteristics of geriatric larynx. Biomater Res 2022; 26:13. [PMID: 35382871 PMCID: PMC8981753 DOI: 10.1186/s40824-022-00261-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Abstract
Aim As the geriatric population increased, the need of treatment for laryngeal atrophy and dysfunction increased. This study was performed to evaluate the effects of injection of human adipose-derived stem cell (hASC) spheroid-loaded catechol-conjugated hyaluronic acid (HA-CA) hydrogel on therapeutic rejuvenation of the geriatric larynx. Methods Stem cell spheroids with hyaluronic acid-based hydrogel were injected into the laryngeal muscles of 18-month-old Sprague–Dawley rats. The effects of hASC spheroids were examined in the following four groups: SHAM, injected with PBS; GEL, injected with HA-CA hydrogel; MONO, injected with single hASCs in HA-CA hydrogel; and SP, injected with hASCs spheroids in HA-CA hydrogel. The rejuvenation efficacy in geriatric laryngeal muscle tissues at 12 weeks postinjection was evaluated and compared by histology, immunofluorescence staining, and functionality analysis. Results Total myofiber cross-sectional area and myofiber number/density, evaluated by detection of myosin heavy chain with antibodies against laminin and fast myosin heavy chain, were significantly higher in the SP group than in the other groups. The lamina propria of the larynx was evaluated by alcian blue staining, which showed that the HA was increased significantly in the SP group compared to the other groups. In functional analysis, the glottal gap area was significantly reduced in the SP group compared to the other groups. The phase difference in the vocal fold during vibration was also smaller in the SP group than in the other groups, but the difference did not reach statistical significance. Conclusion Injection of hASC spheroids with hyaluronic acid-based hydrogel improves the morphological and functional characteristics of geriatric larynx. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40824-022-00261-x.
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Kim J, Eom MR, Ji Jeong E, Choi JS, Kwon SK. Multiple stimulation with spheroids comprising salivary gland and adipose-derived stem cells enhances regeneration of radiation-damaged salivary glands. J IND ENG CHEM 2022. [DOI: 10.1016/j.jiec.2021.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Park SJ, Han SA, Kwon TK, Sung MW, Kwon SK. Primary versus modified secondary closure techniques for persistent tracheocutaneous fistula in pediatric patients. Pediatr Surg Int 2022; 38:123-131. [PMID: 34302512 DOI: 10.1007/s00383-021-04967-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed at compating two closure techniques for tracheocutaneous fistulas (TCFs) in pediatric patients. METHODS A total of 106 consecutive pediatric patients who underwent closure of a persistent TCF between April 2007 and February 2021 at a tertiary pediatric hospital were evaluated, and 103 pediatric patients aged between 12 months and 18 years were included. The clinical characteristics, perioperative outcomes, and postoperative outcomes were compared between TCF closure by primary closure (Group 1) and a modified secondary healing technique (Group 2). RESULTS Of the 103 patients, 58 were classified into Group 1, and 45 into Group 2. The mean age at tracheostomy and TCF closure was significantly younger in Group 2, and the interval between decannulation to TCF closure was significantly shorter in Group 2. Procedural time and hospital stay were significantly shorter in Group 2 than Group 1. Group 2 had a significantly lower complication rate, need for revision surgery, and recannulation rate than Group 1. CONCLUSIONS Modified secondary healing was more efficient in terms of procedural time and hospital stay, and safer (i.e., fewer complications). It is an effective surgical technique for closing a persistent TCF in younger patients more quickly after decannulation compared to primary closure.
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Affiliation(s)
- Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sun A Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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13
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Lee HK, Lim JG, Park JS, Shin SH, Kwon SK, Suh DI. An infant with subglottic cysts presenting as abruptly-progressed stridor and respiratory distress 2 months after extubation. Allergy Asthma Respir Dis 2022. [DOI: 10.4168/aard.2022.10.2.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ha Kyung Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Gyu Lim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Soo Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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14
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Kim YC, Kwon SK. Endoscopic management of pin stuck into the segmental bronchus. Clin Case Rep 2021; 9:e05127. [PMID: 34938541 PMCID: PMC8659608 DOI: 10.1002/ccr3.5127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/10/2021] [Accepted: 11/04/2021] [Indexed: 11/08/2022] Open
Abstract
This case is a challenging case review of a successful removal of sharp and deep located airway foreign body using ventilating bronchoscopy.
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Affiliation(s)
- Young Chul Kim
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University HospitalSeoulKorea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University HospitalSeoulKorea
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University College of MedicineSeoulKorea
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15
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Huh G, Min SH, Cho SD, Cho YJ, Kwon SK. Application and Efficiency of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in Laryngeal Microsurgery. Laryngoscope 2021; 132:1061-1068. [PMID: 34495557 DOI: 10.1002/lary.29848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/26/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to analyze the feasibility of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) during laryngeal microsurgery (LMS) and investigated its efficiency and application according to the location of the lesion. STUDY DESIGN Retrospective chart review. METHODS Patients over 20 years of age who underwent LMS without underlying cardiac, pulmonary, or cerebrovascular disease were retrospectively reviewed. Overall, 54 patients with endotracheal intubation (ETI) and 44 patients with THRIVE were included. The operation and anesthesia time, induction and emergence time, oxygen saturation (SpO2 ), and transcutaneous carbon dioxide (TcCO2 ) levels were analyzed and compared between the two ventilation methods according to disease subsite. RESULTS Compared with ETI, patients with THRIVE presented reduced operation time (16.3 ± 9.69 min vs. 21.9 ± 12.0 min), anesthesia time (33.6 ± 11.4 min vs. 45.4 ± 13.9 min), emergence time (6.73 ± 2.49 min vs. 8.52 ± 3.17 min), without significant decreases in SpO2 but with increased TcCO2 (10.9 ± 6.12% vs. 7.33 ± 3.86%). Comparing THRIVE to ETI for lesions at the glottis yielded similar findings, which were particularly more significant. However, lesions above the glottis presented no significant difference for any parameters between THRIVE and ETI groups. Lesions involving multiple subsites and prolonged operation time were risk factors for the intraoperative conversion of ventilation method. CONCLUSION THRIVE is reliable for maintaining oxygenation during LMS and is efficient in reducing the operation and emergence times, leading to shorter anesthesia time, especially for lesions at the glottis. However, caution is required administering THRIVE, when lesion involves multiple subsites, and when operation time is prolonged. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se-Hee Min
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sung-Dong Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.,Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
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16
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Kang M, Seo HG, Chung E, Lee HH, Yun SJ, Keam B, Kim TM, Kwon SK, Oh B. Effects of percutaneous injection laryngoplasty on voice and swallowing problems in cancer-related unilateral vocal cord paralysis. Laryngoscope Investig Otolaryngol 2021; 6:800-806. [PMID: 34401505 PMCID: PMC8356886 DOI: 10.1002/lio2.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/15/2021] [Accepted: 07/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unilateral vocal cord paralysis may result from nerve compression by tumors or direct nerve injuries during tumor resections, which can cause dysphonia or dysphagia, and reduced quality of life. OBJECTIVES This prospective, single-group study aimed to investigate the effect of percutaneous injection laryngoplasty on voice and swallowing function in patients with cancer-related unilateral vocal cord paralysis. METHODS Patients underwent percutaneous injection laryngoplasty with hyaluronic acid under local anesthesia. Stroboscopy and videofluoroscopic swallowing study were conducted to evaluate the voice- and swallowing-related outcome measures, respectively. The participants were evaluated before injection laryngoplasty, as well as after two weeks and three months. RESULTS Injection laryngoplasty significantly improved the glottal gap, vocal fold position, Maximum Phonation Time, and Voice Handicap Index-10. Post-hoc analysis using Bonferroni correction showed that the improvements occurred within two post-treatment weeks and remained at three post-treatment months. In the subgroup analysis, the patients who underwent injection laryngoplasty within 8 weeks from onset showed significantly higher improvements in the videofluoroscopic dysphagia scale and swallowing function than the patients who received the procedure after 8 weeks or more. CONCLUSION Percutaneous injection laryngoplasty improves glottal closure and voice in patients with cancer-related unilateral vocal cord paralysis. Early injection laryngoplasty may lead to greater benefits on swallowing function. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Min‐Gu Kang
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
- Department of Physical Medicine and RehabilitationDong‐A University College of MedicineBusanRepublic of Korea
| | - Han Gil Seo
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Eun‐Jae Chung
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University HospitalSeoulRepublic of Korea
| | - Hyun Haeng Lee
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University HospitalSeoulRepublic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Bhumsuk Keam
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Tae Min Kim
- Department of Rehabilitation MedicineKonkuk University HospitalSeoulRepublic of Korea
| | - Seong Keun Kwon
- Department of Physical Medicine and RehabilitationDong‐A University College of MedicineBusanRepublic of Korea
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University College of MedicineSeoulRepublic of Korea
- Cancer Research InstituteSeoul National UniversitySeoulRepublic of Korea
| | - Byung‐Mo Oh
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
- Department of Rehabilitation MedicineSeoul National University College of MedicineSeoulRepublic of Korea
- Institute on Aging, Seoul National UniversitySeoulRepublic of Korea
- National Traffic Injury Rehabilitation HospitalYangpyeongRepublic of Korea
- Neuroscience Research Institute, Seoul National University College of MedicineSeoulRepublic of Korea
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17
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Choi JS, Seok J, Eom MR, Jung E, Park SA, Joo SM, Jun YJ, Son KW, Kwon SK. Endoscopically Applied Biodegradable Stent in a Rabbit Model of Pediatric Tracheomalacia. Clin Exp Otorhinolaryngol 2021; 14:328-337. [PMID: 33081438 PMCID: PMC8373836 DOI: 10.21053/ceo.2020.01627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES A polydioxanone (PDO) stent was developed to treat tracheomalacia in pediatric patients. However, its safety and efficacy need to be verified in animal studies before clinical trials in patients can be conducted. This study evaluated the safety and efficacy of a PDO stent in normal and tracheomalacia-model rabbits. METHODS In total, 29 New Zealand white rabbits were used: 13 for evaluating the biocompatibility of the PDO stent in normal rabbits and 16 for the creation of a tracheomalacia model. The tracheomalacia model was successfully established in 12 rabbits, and PDO stents were placed in eight of those rabbits. RESULTS The PDO stent was successfully positioned in the trachea of the normal rabbits using an endoscopic approach, and its degradation was observed 10 weeks later. The stent fragments did not induce distal airway obstruction or damage, and the mucosal changes that occurred after stent placement were reversed after degradation. The same procedure was performed on the tracheomalacia-model rabbits. The survival duration of the tracheomalacia rabbits with and without stents was 49.0±6.8 and 1.0±0.8 days, respectively. Thus, the PDO stent yielded a significant survival gain (P=0.001). In the tracheomalacia rabbits, stent degradation and granulation tissue were observed 7 weeks after placement, leading to airway collapse and death. CONCLUSION We successfully developed a PDO stent and an endoscopic guide placement system. The degradation time of the stent was around 10 weeks in normal rabbits, and its degradation was accelerated in the tracheomalacia model. The mucosal changes associated with PDO stent placement were reversible. Placement of the PDO stent prolonged survival in tracheomalacia-model rabbits.
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Affiliation(s)
- Ji Suk Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Min Rye Eom
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Eungee Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Su A Park
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Daejeon, Korea
| | | | | | | | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
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18
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Jeon MJ, Kim MJ, Kim JH, Park JS, Yim J, Kim M, Kwon SK, Lee S, Ko JM, Chae JH, Suh DI. Multilevel Airway Stenosis Being Bypassed by a Customized Tracheostomy Tube in an Infant with Myhre Syndrome. Pediatr Allergy Immunol Pulmonol 2021; 34:83-87. [PMID: 34143683 DOI: 10.1089/ped.2021.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Myhre syndrome is a rare connective tissue disorder caused by heterozygous pathogenic variants in the SMAD4 gene. Although recognizing Myhre syndrome in early childhood is challenging, it is important to manage airway stenosis in patients with Myhre syndrome. Case Presentation: We report the case of a 2-month-old boy who initially presented with severe multilevel airway stenosis, dysmorphic face, and multiple abnormalities. Lung fibrosis and mild aortic valve stenosis were additionally observed on follow-up examinations. A heterozygous missense variant, c.1499T>C (p.Ile500Thr), in SMAD4 was identified through exome sequencing. Tracheostomy was performed, and the patient has maintained stable respiration through a customized tracheostomy tube with a home ventilator. Conclusions: Patients who have dysmorphic face, airway stenosis, and cardiovascular anomalies that do not fit the diagnosis of common syndromes should be evaluated for rare diseases, including Myhre syndrome. Since respiratory complications can be life threatening, early diagnosis and suitable intervention are necessary.
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Affiliation(s)
- Min Jin Jeon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Soo Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jisook Yim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Genetic Laboratory Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Genetic Laboratory Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soyoung Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Min Ko
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.,Rare Disease Center, Seoul National University Hospital, Seoul, Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.,Rare Disease Center, Seoul National University Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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19
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Choi JS, Lee MS, Kim J, Eom MR, Jeong EJ, Lee M, Park SA, Jeong JH, Kwon SK. Hyaluronic Acid Coating on Hydrophobic Tracheal Scaffold Enhances Mesenchymal Stem Cell Adhesion and Tracheal Regeneration. Tissue Eng Regen Med 2021; 18:225-233. [PMID: 33765289 DOI: 10.1007/s13770-021-00335-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/05/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Long segmental tracheal repair is challenging in regenerative medicine due to low adhesion of stem cells to tracheal scaffolds. Optimal transplantation of stem cells for tracheal defects has not been established. We evaluated the role of hyaluronic acid (HA) coating of tracheal scaffolds in mesenchymal stem cell (MSC) adhesion and tracheal regeneration in a rabbit model. METHODS A three-dimensionally printed tubular tracheal prosthesis was incubated with dopa-HA-fluorescein isothiocyanate in phosphate-buffered saline for 2 days. MSCs were incubated with an HA-coated scaffold, and their adhesion was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. HA coated scaffolds with or without MSC seeding were transplanted at the circumferential tracheal defect in rabbits, and survival, rigid bronchoscopy, radiologic findings, and histologic findings were compared between the two groups. RESULTS HA-coated scaffolds showed better MSC adhesion than non-coated scaffolds. The HA-coated scaffolds with MSC group showed a wider airway and greater mucosal regeneration compared to the HA-coated scaffolds without MSC group. CONCLUSION HA coating of scaffolds can promote MSC adhesion and tracheal regeneration.
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Affiliation(s)
- Ji Suk Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu Seoul, 03080, Republic of Korea
| | - Min Sang Lee
- School of Pharmacy, Theranostic Macromolecules Research Center, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, 16419, Republic of Korea
| | - Jooyoung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu Seoul, 03080, Republic of Korea
| | - Min Rye Eom
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu Seoul, 03080, Republic of Korea
| | - Eun Ji Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu Seoul, 03080, Republic of Korea
| | - Minhyung Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul, 03080, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu Seoul, 03080, Republic of Korea
| | - Su A Park
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, 156 Gajeongbuk-ro, Yuseong-gu, Daejeon, 34103, Republic of Korea
| | - Ji Hoon Jeong
- School of Pharmacy, Theranostic Macromolecules Research Center, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, 16419, Republic of Korea.
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu Seoul, 03080, Republic of Korea. .,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul, 03080, Republic of Korea. .,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu Seoul, 03080, Republic of Korea. .,Cancer Research Institute, Seoul National University, 101 Daehak-ro, Jongno-gu Seoul, 03080, Republic of Korea.
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20
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Cha H, Lee DY, Kim EH, Lee JH, Jang YE, Kim HS, Kwon SK. Feasibility of Surgical Treatment for Laryngomalacia using Spontaneous Respiration Technique. Clin Exp Otorhinolaryngol 2021; 14:414-423. [PMID: 33541038 PMCID: PMC8606294 DOI: 10.21053/ceo.2020.02061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/08/2021] [Indexed: 12/29/2022] Open
Abstract
Objectives. In this study, we review our institutional experience with pediatric laryngomalacia (LM) and report our experiences of patients undergoing supraglottoplasty using the spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen (STRIVE Hi) technique. Methods. The medical records of 29 children with LM who visited Seoul National University Hospital between January 2017 and March 2019 were retrospectively reviewed. Surgical management was performed using the STRIVE Hi technique. Intraoperative findings and postoperative surgical outcomes, including complications and changes in symptoms and weight, were analyzed. Results. Of the total study population of 29 subjects, 20 (68.9%) were female. The patients were divided according to the Onley classification as follows: type I (n=13, 44.8%), II (n=10, 34.5%), and III (n=6, 20.7%). Twenty-five patients (86.2%) had comorbidities. Seventeen patients (58.6%) underwent microlaryngobronchoscopy under STRIVE Hi anesthesia. Four patients with several desaturation events required rescue oxygenation by intermittent intubation and mask bagging during the STRIVE Hi technique. However, the procedure was completed in all patients without any severe adverse effects. Overall, 15 children (51.7%) underwent supraglottoplasty, of whom 14 (93.3%) showed symptom improvement, and their postoperative weight percentile significantly increased (P=0.026). One patient required tracheostomy immediately after supraglottoplasty due to associated neurological disease. Conclusion. The STRIVE Hi technique is feasible for supraglottoplasty in LM patients, while type III LM patients with micrognathia or glossoptosis may have a higher risk of requiring rescue oxygenation during the STRIVE Hi technique.
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Affiliation(s)
- Hyunkyung Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University college of medicine, Seoul, Republic of Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University college of medicine, Seoul, Republic of Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University college of medicine, Seoul, Republic of Korea
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21
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Ha H, Keam B, Ock CY, Kim TM, Kim JH, Chung EJ, Kwon SK, Ahn SH, Wu HG, Sung MW, Heo DS. Role of concurrent chemoradiation on locally advanced unresectable adenoid cystic carcinoma. Korean J Intern Med 2021; 36:175-181. [PMID: 32218101 PMCID: PMC7820661 DOI: 10.3904/kjim.2019.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/26/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Adenoid cystic carcinoma (ACC) is a rare salivary gland tumor characterized by indolence, with a high rate of local recurrence and distant metastasis. This study aimed to investigate the effect of concurrent chemoradiation (CCRT) on locally advanced unresectable ACC. METHODS We retrospectively analyzed clinical data from 10 patients with pathologically confirmed ACC of the head and neck who received CCRT with cisplatin in Seoul National University Hospital between 2013 and 2018. RESULTS Ten patients with unresectable disease at the time of diagnosis or with positive margins after surgical resection received CCRT with weekly cisplatin. Eight patients (80%) achieved complete remission, of which three later developed distant metastases without local relapse; one patient developed distant metastasis and local relapse. Two patient achieved partial remission without progression. Patients experienced several toxicities, including dry mouth, radiation dermatitis, nausea, and salivary gland inflammation of mostly grade 1 to 2. Only one patient showed grade 3 oral mucositis. Median relapse-free survival was 34.5 months (95% confidence interval, 22.8 months to not reached). CONCLUSION CCRT with cisplatin is effective for local control of ACC with manageable toxicity and may be an effective treatment option for locally advanced unresectable ACC.
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Affiliation(s)
- Hyerim Ha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Bhumsuk Keam, M.D. Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-7215 Fax: +82-2-2072-7379 E-mail:
| | - Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Lee M, Choi JS, Eom MR, Jeong EJ, Kim J, Park SA, Kwon SK. Prevascularized Tracheal Scaffolds Using the Platysma Flap for Enhanced Tracheal Regeneration. Laryngoscope 2020; 131:1732-1740. [PMID: 33135799 DOI: 10.1002/lary.29178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES One of the greatest hurdles in tracheal tissue engineering is insufficient vascularization, which leads to delayed mucosal regeneration, inflammation, and restenosis. This study investigated whether a prevascularized segmental tracheal substitute using platysma can enhance tracheal mucosal regeneration. METHODS Three-dimensional (3D) printed scaffolds with (group M) or without (group S) Matrigel coating were implanted under the feeding vessels of the platysma in New Zealand White rabbits (n = 3) to induce vascularization. After 1 or 2 weeks, tracheal defects were created and vascularized scaffolds with feeders of the platysma were transplanted as rotational flaps. As controls, scaffolds with or without Matrigel coating was transplanted into a tracheal defect without prevascularization. Airway patency and epithelization were examined using a rigid bronchoscope every 2 weeks. Surviving animals were euthanized at 24 weeks, and microcomputed tomography and histological evaluation were performed. RESULTS Animals with 2 weeks of prevascularization showed longer survival than animals with 0 or 1 weeks of prevascularization regardless of the Matrigel coating. Wider airway patency was observed in group M than group S. Group M showed migration of epithelium over the scaffold from 4 weeks after transplantation and complete coverage with epithelium at 12 weeks, whereas group S showed migration of the epithelium from 14 weeks and incomplete coverage with epithelium even at 24 weeks. CONCLUSION This two-step method, utilizing the platysma as an in vivo bioreactor, may be a promising approach to achieve long-term survival and enhanced luminal patency. Matrigel coating on the scaffold had a synergistic effect on epithelial regeneration. LEVEL OF EVIDENCE NA Laryngoscope, 131:1732-1740, 2021.
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Affiliation(s)
- Minhyung Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Suk Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Rye Eom
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Ji Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jooyoung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Su A Park
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Daejeon, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Lee JSJ, Kim SJ, Choi JS, Eom MR, Shin H, Kwon SK. Adipose-derived mesenchymal stem cell spheroid sheet accelerates regeneration of ulcerated oral mucosa by enhancing inherent therapeutic properties. J IND ENG CHEM 2020. [DOI: 10.1016/j.jiec.2020.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kim IG, Park SA, Lee SH, Choi JS, Cho H, Lee SJ, Kwon YW, Kwon SK. Transplantation of a 3D-printed tracheal graft combined with iPS cell-derived MSCs and chondrocytes. Sci Rep 2020; 10:4326. [PMID: 32152475 PMCID: PMC7062776 DOI: 10.1038/s41598-020-61405-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/24/2020] [Indexed: 11/09/2022] Open
Abstract
For successful tracheal reconstruction, tissue-engineered artificial trachea should meet several requirements, such as biocompatible constructs comparable to natural trachea, coverage with ciliated respiratory mucosa, and adequate cartilage remodeling to support a cylindrical structure. Here, we designed an artificial trachea with mechanical properties similar to the native trachea that can enhance the regeneration of tracheal mucosa and cartilage through the optimal combination of a two-layered tubular scaffold and human induced pluripotent stem cell (iPSC)-derived cells. The framework of the artificial trachea was fabricated with electrospun polycaprolactone (PCL) nanofibers (inner) and 3D-printed PCL microfibers (outer). Also, human bronchial epithelial cells (hBECs), iPSC-derived mesenchymal stem cells (iPSC-MSCs), and iPSC-derived chondrocytes (iPSC-Chds) were used to maximize the regeneration of tracheal mucosa and cartilage in vivo. After 2 days of cultivation using a bioreactor system, tissue-engineered artificial tracheas were transplanted into a segmental trachea defect (1.5-cm length) rabbit model. Endoscopy did not reveal granulation ingrowth into tracheal lumen. Alcian blue staining clearly showed the formation of ciliated columnar epithelium in iPSC-MSC groups. In addition, micro-CT analysis showed that iPSC-Chd groups were effective in forming neocartilage at defect sites. Therefore, this study describes a promising approach for long-term functional reconstruction of a segmental tracheal defect.
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Affiliation(s)
- In Gul Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Su A Park
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Daejeon, 34103, Republic of Korea
| | - Shin-Hyae Lee
- Biomedical Research Institute Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Ji Suk Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Hana Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Sang Jin Lee
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Daejeon, 34103, Republic of Korea
| | - Yoo-Wook Kwon
- Biomedical Research Institute Seoul National University Hospital, Seoul, 03080, Republic of Korea.
| | - Seong Keun Kwon
- Biomedical Research Institute Seoul National University Hospital, Seoul, 03080, Republic of Korea.
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Lee SJ, Choi JS, Eom MR, Jo HH, Kwon IK, Kwon SK, Park SA. Dexamethasone loaded bilayered 3D tubular scaffold reduces restenosis at the anastomotic site of tracheal replacement: in vitro and in vivo assessments. Nanoscale 2020; 12:4846-4858. [PMID: 32016227 DOI: 10.1039/c9nr10341d] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Despite recent developments in the tracheal tissue engineering field, the creation of a patient specific substitute possessing both appropriate mechanical and biointerfacial properties remains challenging. Most tracheal replacement therapies fail due to restenosis at the anastomosis site. In this study, we designed a robust, biodegradable, 3D tubular scaffold by combining electrospinning (ELSP) and 3D (three-dimensional) printing techniques for use in transplantation therapy. After that, we loaded dexamethasone (DEX) onto the 3D tubular scaffold using mild surface modification reactions by using polydopamine (PDA), polyethyleneimine (PEI), and carboxymethyl-β-cyclodextrin (βCD). As a result, the fabricated 3D tubular scaffold had robust mechanical properties and the chemical modifications were confirmed to have proceeded successfully by physico-chemical analysis. The surface treatments allowed for a larger amount of DEX to be loaded onto the βCD modified scaffold as compared to the bare group. In vitro and in vivo studies demonstrated that the DEX loaded 3D tubular scaffold exhibited significantly enhanced anti-inflammation activity, enhanced tracheal mucosal regeneration, and formation of a patent airway. From our results, we believe that our system may represent an innovative paradigm in tracheal tissue engineering by providing proper mechanical properties and successful formation of tracheal tissue as a means of remodeling and healing tracheal defects for use in transplantation therapy.
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Affiliation(s)
- Sang Jin Lee
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, 156 Gajeongbuk-ro, Yuseong-gu, Daejeon 34103, Republic of Korea. and Department of Dental Materials, School of Dentistry, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Ji Suk Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Min Rye Eom
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Ha Hyeon Jo
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, 156 Gajeongbuk-ro, Yuseong-gu, Daejeon 34103, Republic of Korea.
| | - Il Keun Kwon
- Department of Dental Materials, School of Dentistry, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea. and Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su A Park
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, 156 Gajeongbuk-ro, Yuseong-gu, Daejeon 34103, Republic of Korea.
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Choi JS, Huh BK, Lee SJ, Han MJ, Eom MR, Ahn HJ, Jin YJ, Park SA, Choy YB, Kwon SK. Tranilast-loaded tubular scaffold and surgical suture for suppression of stenosis after tracheal prosthesis transplantation. J IND ENG CHEM 2020. [DOI: 10.1016/j.jiec.2019.09.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Huh G, Ahn SH, Suk JG, Lee MH, Kim WS, Kwon SK, Ock CY, Keam B, Heo DS, Kim JH, Wu HG. Severe late dysphagia after multimodal treatment of stage III/IV laryngeal and hypopharyngeal cancer. Jpn J Clin Oncol 2019; 50:185-192. [DOI: 10.1093/jjco/hyz158] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/02/2019] [Indexed: 12/18/2022] Open
Abstract
Abstract
Background
Long-term side effects after radiotherapy for organ preservation ‘could deteriorate’ the laryngeal function. This study intended to identify the incidence of severe late dysphagia following the multimodal treatment for stage III/IV laryngeal and hypopharyngeal cancer ‘to evaluate the function of larynx’.
Methods
The medical records of patients successfully treated for laryngeal and hypopharyngeal cancer with a multimodal approach, including radiotherapy, were retrospectively analyzed. ‘Functional larynx was defined as tolerable oral diet without severe late dysphagia or tracheostoma’.
Results
The study included 99 patients with a median follow-up period of 72 months. ‘Tracheostomy during the follow-up period was required in only one patient due to aspiration pneumonia, and dysphagia is the main determinant for functional larynx’. The probability of maintaining functional larynx was 63% for 10 years, when the treatment was started with radiotherapy or concurrent chemoradiotherapy. In upfront surgery (operation first and adjuvant radiotherapy/concurrent chemoradiotherapy) group, 37% of patients required total laryngectomy as primary treatment and 43% of patients could maintain laryngeal function for 10 years. And severe late dysphagia in the latter group developed mainly after laryngeal preservation surgery. The patients aged ≥65 years showed significantly higher incidence of dysphagia. Severe late dysphagia was very rare in laryngeal cancer successfully cured with radiotherapy/concurrent chemoradiotherapy (1/25, 4%); however, it gradually increased over time in hypopharyngeal cancer patients showing a statistically significant difference from laryngeal cancer patients (P = 0.040).
Conclusion
Severe late dysphagia occurred in 19.2% of patients treated for laryngeal and hypopharyngeal cancers, regardless of whether treatment started with radiotherapy/concurrent chemoradiotherapy or surgery.
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Affiliation(s)
- Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jun-Girl Suk
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Min-Hyung Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Won Shik Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea, and
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea, and
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea, and
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
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Yoo SH, Ock CY, Keam B, Park SJ, Kim TM, Kim JH, Jeon YK, Chung EJ, Kwon SK, Hah JH, Kwon TK, Jung KC, Kim DW, Wu HG, Sung MW, Heo DS. Poor prognostic factors in human papillomavirus-positive head and neck cancer: who might not be candidates for de-escalation treatment? Korean J Intern Med 2019; 34:1313-1323. [PMID: 30428646 PMCID: PMC6823569 DOI: 10.3904/kjim.2017.397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/06/2018] [Accepted: 05/02/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Since patients with human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) have favorable outcomes after treatment, treatment de-escalation for these patients is being actively investigated. However, not all HPV-positive HNSCCs are curable, and some patients have a poor prognosis. The purpose of this study was to identify poor prognostic factors in patients with HPV-positive HNSCC. METHODS Patients who received a diagnosis of HNSCC and tested positive for HPV from 2000 to 2015 at a single hospital site (n = 152) were included in this retrospective analysis. HPV typing was conducted using the HPV DNA chip assay or liquid bead microarray system. Expression of p16 in the tumors was assessed by immunohistochemistry. To determine candidate factors associated with overall survival (OS), univariate and multivariable Cox regression analyses were performed. RESULTS A total of 152 patients with HPV-positive HNSCC were included in this study; 82.2% were male, 43.4% were current or former smokers, and 84.2% had oropharyngeal cancer. By univariate analysis, old age, performance status ≥ 1, non-oropharyngeal location, advanced T classification (T3-4), and HPV genotype 18 were significantly associated with poor OS. By multivariable analysis, performance status ≥ 1 and non-oropharyngeal location were independently associated with shorter OS (hazard ratio [HR], 4.36, p = 0.015; HR, 11.83, p = 0.002, respectively). Furthermore, HPV genotype 18 positivity was also an independent poor prognostic factor of OS (HR, 10.87, p < 0.001). CONCLUSION Non-oropharyngeal cancer, poor performance status, and HPV genotype 18 were independent poor prognostic factors in patients with HPV-positive HNSCC. Patients with these risk factors might not be candidates for de-escalation treatment.
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Affiliation(s)
- Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Joon Park
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - J. Hun Hah
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Kyeong Chun Jung
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Kim IG, Wu Y, Park SA, Cho H, Choi JJ, Kwon SK, Shin JW, Chung EJ. Tissue-Engineered Esophagus via Bioreactor Cultivation for Circumferential Esophageal Reconstruction. Tissue Eng Part A 2019; 25:1478-1492. [DOI: 10.1089/ten.tea.2018.0277] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- In Gul Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Yanru Wu
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Su A. Park
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Daejeon, Republic of Korea
| | - Hana Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Jun Jae Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Jung-Woog Shin
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
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Kang BH, Yu T, Kim JH, Park JM, Kim JI, Chung EJ, Kwon SK, Kim JH, Wu HG. Early Closure of a Phase 1 Clinical Trial for SABR in Early-Stage Glottic Cancer. Int J Radiat Oncol Biol Phys 2019; 105:104-109. [DOI: 10.1016/j.ijrobp.2019.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 01/29/2023]
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Seok J, Lee DY, Kim WS, Jeong WJ, Chung EJ, Jung YH, Kwon SK, Kwon TK, Sung MW, Ahn SH. Lung metastasis in adenoid cystic carcinoma of the head and neck. Head Neck 2019; 41:3976-3983. [PMID: 31463986 DOI: 10.1002/hed.25942] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/26/2019] [Accepted: 08/15/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Distant metastasis of adenoid cystic carcinoma (ACC) is most commonly identified in the lung, but risk factors are still on debate. METHODS Risk factors for lung metastasis were evaluated by using Cox proportional hazards model and Kaplan-Meier curves. RESULTS Of 112 patients, 48% had distant metastasis; 94.4% of whom had lung metastasis. Univariable analysis revealed sublingual or minor salivary gland, tumor size ≥2.5 cm, and perineural invasion as risk factors (hazard ratio [HR]: 1.99 [1.02-3.91], 2.57 [1.19-5.58], and 2.46 [1.28-4.74], respectively), whereas size, perineural invasion, and local recurrence were risk factors in multivariable analysis (HR: 2.29 [1.05-4.96], 2.32 [1.09-4.96], and 2.68 [1.24-5.79], respectively). CONCLUSION Sublingual gland or minor salivary glands ACC has a higher risk of lung metastasis. If the site is not considered, the following factors increased the risk of lung metastasis; (a) size ≥2.5 cm, (b) perineural invasion, and (c) local recurrence.
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Affiliation(s)
- Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Won Shik Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Young Ho Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
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Shih YRV, Liu M, Kwon SK, Iida M, Gong Y, Sangaj N, Varghese S. Dysregulation of ectonucleotidase-mediated extracellular adenosine during postmenopausal bone loss. Sci Adv 2019; 5:eaax1387. [PMID: 31457100 PMCID: PMC6703860 DOI: 10.1126/sciadv.aax1387] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/12/2019] [Indexed: 05/25/2023]
Abstract
Adenosine and its receptors play a key role in bone homeostasis and regeneration. Extracellular adenosine is generated from CD39 and CD73 activity in the cell membrane, through conversion of adenosine triphosphate to adenosine monophosphate (AMP) and AMP to adenosine, respectively. Despite the relevance of CD39/CD73 to bone health, the roles of these enzymes in bona fide skeletal disorders remain unknown. We demonstrate that CD39/CD73 expression and extracellular adenosine levels in the bone marrow are substantially decreased in animals with osteoporotic bone loss. Knockdown of estrogen receptors ESR1 and ESR2 in primary osteoprogenitors and osteoclasts undergoing differentiation showed decreased coexpression of membrane-bound CD39 and CD73 and lower extracellular adenosine. Targeting the adenosine A2B receptor using an agonist attenuated bone loss in ovariectomized mice. Together, these findings suggest a pathological association of purine metabolism with estrogen deficiency and highlight the potential of A2B receptor as a target to treat osteoporosis.
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Affiliation(s)
- Yu-Ru V. Shih
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Mengqian Liu
- Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - Seong Keun Kwon
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | | | - Ya Gong
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Nivedita Sangaj
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Shyni Varghese
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
- Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
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Yoo SH, Keam B, Ock CY, Kim S, Han B, Kim JW, Lee KW, Jeon YK, Jung KC, Chung EJ, Kwon SK, Ahn SH, Sung MW, Heo DS. Prognostic value of the association between MHC class I downregulation and PD-L1 upregulation in head and neck squamous cell carcinoma patients. Sci Rep 2019; 9:7680. [PMID: 31118488 PMCID: PMC6531443 DOI: 10.1038/s41598-019-44206-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/10/2019] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study was to evaluate the prognostic impact of major histocompatibility complex (MHC) class I expression and programmed death-ligand 1 (PD-L1) expression in patients with head and neck squamous cell carcinoma (HNSCC). A total of 158 patients with HNSCC were evaluated retrospectively. The expression of MHC class I and PD-L1 was analyzed in tumor specimens using immunohistochemistry. The association between MHC class I/PD-L1 expression and clinical outcome was evaluated by Kaplan-Meier and Cox regression analyses. Among 158 patients, 103 (65.2%) showed positive PD-L1 expression, and 20 (12.7%) showed no detectable expression of MHC class I. The frequency of PD-L1 positive expression with concomitant MHC class I loss was 7.0%. In the PD-L1-positive group, MHC class I loss was associated with a significantly worse survival compared with MHC class I positivity (median overall survival 39.3 months vs. not reached; P = 0.005), whereas MHC class I status provided no prognostic impact in the PD-L1 negative group. Neither PD-L1 nor MHC class I alone showed a significant difference in overall survival. The loss of MHC class I expression in PD-L1-positive HNSCC was associated with a poor clinical outcome. This suggested that MHC class I expression status might be useful for the prognosis of tumor progression in HNSCC when combined with PD-L1 expression status. External validation with enough numbers of participants in such subgroup should be needed for validation.
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Affiliation(s)
- Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sehui Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Buhm Han
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyeong Cheon Jung
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Choi YH, Kim SH, Kim IG, Lee JH, Kwon SK. Injectable basic fibroblast growth factor-loaded alginate/hyaluronic acid hydrogel for rejuvenation of geriatric larynx. Acta Biomater 2019; 89:104-114. [PMID: 30849562 DOI: 10.1016/j.actbio.2019.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 01/01/2023]
Abstract
Increase in the geriatric population has led to an increase in the number of elderly patients with laryngeal atrophy and dysfunction. Symptoms of voice change, dysphagia, and aspiration pneumonia negatively influence patient's health status, quality of life, and life span. Injection laryngoplasty used to treat laryngeal dysfunctions does not recover intrinsic functions of the larynx. Thus, we fabricated an injectable basic fibroblast growth factor (bFGF)-loaded alginate (ALG)/hyaluronic acid (HA) hydrogel for inducing rejuvenation of geriatric laryngeal muscles. Optimal in situ-forming bFGF-loaded ALG/HA hydrogel for injection laryngoplasty was prepared and the release profile of bFGF was analyzed. For in vivo analysis, the bFGF-loaded ALG/HA hydrogel was injected into the laryngeal muscles of 18-month-old Sprague-Dawley rats. The rejuvenation efficacy of bFGF-loaded ALG/HA hydrogel in geriatric laryngeal muscle tissues 4- and 12-weeks post-injection was evaluated by quantitative polymerase chain reaction (qPCR), histology, immune-fluorescence staining and functionality analysis. The bFGF-loaded ALG/HA hydrogel induced an increase in the expression of myogenic regulatory factor-related genes, hypertrophy of muscle fiber, proliferation of muscle satellite cells, and angiogenesis and decreased interstitial fibrosis. Administration of the bFGF-loaded ALG/HA hydrogel caused successful glottal gap closure. Thus, the bFGF-loaded ALG/HA hydrogel could be a promising candidate for laryngoplasty aimed at rejuvenating geriatric larynx. STATEMENT OF SIGNIFICANCE: In this manuscript, optimal in situ-forming bFGF-loaded ALG/HA hydrogel for injection laryngoplasty was prepared and the release profile of bFGF was analyzed. Herein, we introduced the materials and methods of injection laryngoplasty for geriatric rat experiment. In addition, we studied effects of bFGF-loaded ALG/HA hydrogel on the therapeutic rejuvenation of geriatric rat larynx. The bFGF-loaded ALG/HA hydrogel induced an increase in the expression of myogenic regulatory factor-related genes, hypertrophy of muscle fiber, proliferation of muscle satellite cells, and angiogenesis and decreased interstitial fibrosis. Furthermore, our functional analysis through the high-speed camera setup demonstrated that the administration of the bFGF-loaded ALG/HA hydrogel induced successful glottal gap closure. Thus, the bFGF-loaded ALG/HA hydrogel could be a promising candidate for injection laryngoplasty with therapeutic effects.
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Affiliation(s)
- Young Hwan Choi
- Department of Otorhinolaryngology-Head and Neck, Seoul National University Hospital, Seoul 03080, Republic of Korea; School of Chemical and Biological Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Sae Hyun Kim
- Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon 34054, Republic of Korea
| | - In Gul Kim
- Department of Otorhinolaryngology-Head and Neck, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon 34054, Republic of Korea.
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck, Seoul National University Hospital, Seoul 03080, Republic of Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Choi YH, Ahn HJ, Park MR, Han MJ, Lee JH, Kwon SK. Dual growth factor-immobilized bioactive injection material for enhanced treatment of glottal insufficiency. Acta Biomater 2019; 86:269-279. [PMID: 30599245 DOI: 10.1016/j.actbio.2018.12.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/19/2018] [Accepted: 12/28/2018] [Indexed: 01/27/2023]
Abstract
With increasing demand for treatment of glottal insufficiency, several injection materials have been examined. However, biological resorption, degradation of injected materials, and the subsequent need to perform multiple injections still remain major clinical problems. In this study, we fabricated two different growth factor (GF) [single basic fibroblast growth factor (bFGF), single hepatocyte growth factor (HGF), or dual bFGF/HGF]-immobilized polycaprolactone (PCL)/Pluronic F127 microspheres. These materials were investigated for their potential use as bioactive injection laryngoplasty agents. HGF was found to be continuously released over 20 days and the bFGF was found to be continuously released over 25 days, as demonstrated by ELISA assay. Human vocal fold fibroblasts (hVFFs) showed significantly higher proliferative ability on dual GF-immobilized microspheres. GF-immobilized microspheres (bFGF, HGF, and dual GF) were injected into paralyzed vocal folds of New Zealand white rabbits. Through endoscopic observation and H&E staining, we identified that the microspheres remained localized at the injection site, resulting in constant volume augmentation of the paralyzed vocal fold without significant loss of the initial volume after 4 weeks. The expression of genes related to the extracellular matrix (ECM) in the vocal fold was upregulated by dual GF-immobilized microspheres. Furthermore, dual GF-immobilized microspheres inhibited muscle degeneration and upregulation of myogenic-related genes. In conclusion, dual GF-immobilized microspheres passively augmented the volume of the paralyzed vocal fold while actively inducing ECM synthesis at the injected vocal fold and preserving muscle tissue. Dual GF-immobilized microspheres could be a new and promising injection material for paralyzed vocal folds. STATEMENT OF SIGNIFICANCE: Limitation of prolonged augmentation of vocal fold and degeneration of vocal fold tissue still remain as major clinical problems in the treatment of vocal fold paralysis. Herein, we fabricated the polycaprolactone (PCL)/Pluronic F127 microspheres to augment volume of paralyzed vocal folds. On top of that, we additionally immobilized the growth factors (bFGF, HGF, or dual bFGF/HGF) on the surface of these microspheres. We highlight the efficacy of the dual GF-immobilized microspheres which augmented the volume of the paralyzed vocal fold passively, induced ECM synthesis actively at the injected vocal fold and preserved laryngeal muscle tissue. Our results suggest that the dual GF-immobilized microsphere could be a new promising injection material for injection laryngoplasty to treat paralyzed vocal fold.
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Affiliation(s)
- Young Hwan Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea; School of Chemical and Biological Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Hee-Jin Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mi Ri Park
- Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon, Republic of Korea
| | - Mi-Jung Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon, Republic of Korea.
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Keam B, Lee KW, Lee SH, Kim JS, Kim JH, Wu HG, Eom KY, Kim S, Ahn SH, Chung EJ, Kwon SK, Jeong WJ, Jung YH, Kim JW, Heo DS. A Phase II Study of Genexol-PM and Cisplatin as Induction Chemotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma. Oncologist 2019; 24:751-e231. [PMID: 30796155 PMCID: PMC6656523 DOI: 10.1634/theoncologist.2019-0070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/23/2019] [Indexed: 12/16/2022] Open
Abstract
Lessons Learned. Induction chemotherapy with Genexol‐PM and cisplatin demonstrated modest tumor response in locally advanced head and neck squamous cell carcinoma. Considering favorable toxicity profiles and promising survival data, further studies on this regimen are warranted in patients with head and neck squamous cell carcinoma.
Background. Genexol‐PM is a polymeric micellar formulation of paclitaxel without Cremophor EL. We investigated the efficacy and safety of Genexol‐PM plus cisplatin as induction chemotherapy (IC) in patients with locally advanced head and neck squamous cell carcinoma (LA‐HNSCC). Methods. Patients received Genexol‐PM (230 mg/m2) and cisplatin (60 mg/m2) every 3 weeks as IC. After three cycles of IC, definitive treatment of either concurrent chemoradiotherapy (CCRT) with weekly cisplatin (30 mg/m2) or surgery was performed. The primary endpoint was overall response rate (ORR) after IC. Results. Of 52 patients enrolled, 47 completed three cycles of IC, and the ORR was 55.8% (95% confidence interval, 42.3–69.3). Although there was one treatment‐related death, toxicity profiles to Genexol‐PM and cisplatin were generally favorable, and the most common grade 3 or 4 toxicities were neutropenia (15.4%), anorexia (7.7%), and general weakness (7.7%). Fifty‐one patients received definitive treatment (CCRT [n = 44] or radical surgery [n = 7]). The rate of complete response following CCRT was 81.8% (36/44). After a median follow‐up of 39 months, estimates of progression‐free survival (PFS) and overall survival (OS) at 3 years were 54.3% and 71.3%, respectively. Conclusion. IC with Genexol‐PM and cisplatin demonstrated modest tumor response with well‐tolerated toxicity profiles for patients with LA‐HNSCC.
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Affiliation(s)
- Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se-Hoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Soo Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Suzy Kim
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Young Ho Jung
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji-Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, Roh JL, Park YM, Park IS, Park JJ, Shin SC, Ahn SH, Won S, Ryu CH, Yoon TM, Lee G, Lee DY, Lee MC, Lee JK, Lee JC, Lim JY, Chang JW, Jang JY, Chung MK, Jung YS, Cho JG, Choi YS, Choi JS, Lee GH, Chung PS. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2019; 12:107-144. [PMID: 30703871 PMCID: PMC6453784 DOI: 10.21053/ceo.2018.01816] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient’s treatment goals.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Bon Seok Koo
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Innchul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jung Je Park
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjun Won
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Tae Mi Yoon
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Giljoon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Chul Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Joon Kyoo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeon Yeob Jang
- Department of Otorhinolaryngology Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yuh-Seok Jung
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong-Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University School of Medicine, Incheon, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Phil-Sang Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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Chung EJ, Jeong WJ, Jung YH, Kwon SK, Kwon TK, Ahn SH, Sung MW, Keam B, Heo DS, Kim JH, Wu HG, Lee KW, Eom KY, Rho YS. Long-term oncological and functional outcomes of induction chemotherapy followed by (chemo)radiotherapy vs definitive chemoradiotherapy vs surgery-based therapy in locally advanced stage III/IV hypopharyngeal cancer: Multicenter review of 266 cases. Oral Oncol 2019; 89:84-94. [PMID: 30732965 DOI: 10.1016/j.oraloncology.2018.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/18/2018] [Accepted: 12/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the treatment outcomes for stage III/IV locally advanced hypopharyngeal squamous cell carcinoma (SCC), comparing induction chemotherapy followed by (chemo)radiotherapy (ICT), definitive chemoradiotherapy (CRT) and surgery-based therapy (SRT). SUBJECTS AND METHODS Two hundred sixty-six patients with stage III/IV locally advanced hypopharyngeal squamous cell carcinoma (SCC) who underwent ICT (n = 74), CRT (n = 53) or SRT (n = 139) from 1997 through 2014 at the Seoul National University Hospital (n = 127) and the Hallym University Medical Center (n = 139) were enrolled in the study. All surgical procedures in the SRT group were performed by a single surgeon to eliminate surgeon bias. RESULTS The 5-year disease-free survival (DFS) and overall survival (OS) of all patients (n = 266) were 59.4% and 44%, respectively. The 5-year DFS rates after salvage treatment were 52.7% for ICT, 52.8% for CRT and 65.5% for SRT (p = 0.194). The OS rates were 44.6% for ICT, 39.6% for CRT and 45.3% for SRT group (p = 0.106). The salvage rates were 12.5% for ICT, 15.6% for CRT and 3.8% for SRT group. The final laryngeal preservation rate was significantly lower in the SRT group (44.6%) than in the ICT (71.6%) or CRT (71.7%) groups. All major postoperative complications were significantly higher in the salvage surgery group. CONCLUSION Treatment outcomes in the ICT and CRT groups were comparable to that of the SRT group for stage III/IV hypopharyngeal SCC. However, the relatively low chance of cure and high risk of complications should be taken into account when considering salvage surgery.
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Affiliation(s)
- Eun-Jae Chung
- Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Jung
- Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Myung-Whun Sung
- Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bhumsuk Keam
- Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dae-Seog Heo
- Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Ho Kim
- Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong-Gyun Wu
- Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keun-Yong Eom
- Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine, Seoul, Republic of Korea.
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Kim IG, Park MR, Choi YH, Choi JS, Ahn HJ, Kwon SK, Lee JH. Regeneration of Paralyzed Vocal Fold by the Injection of Plasmid DNA Complex-Loaded Hydrogel Bulking Agent. ACS Biomater Sci Eng 2019; 5:1497-1508. [DOI: 10.1021/acsbiomaterials.8b01541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- In Gul Kim
- Department of Otorhinolaryngology—Head and Neck Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Mi Ri Park
- Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon 34054, Republic of Korea
| | - Young Hwan Choi
- Department of Otorhinolaryngology—Head and Neck Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Ji Suk Choi
- Department of Otorhinolaryngology—Head and Neck Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Hee-Jin Ahn
- Department of Otorhinolaryngology—Head and Neck Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology—Head and Neck Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon 34054, Republic of Korea
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Lee JSJ, Park J, Shin DA, Ryu YJ, Kim HC, Lee JC, Kwon SK. Characterization of the biomechanical properties of canine trachea using a customized 3D-printed apparatus. Auris Nasus Larynx 2018; 46:407-416. [PMID: 30392980 DOI: 10.1016/j.anl.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/04/2018] [Accepted: 10/17/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The canine trachea is considered to be an excellent preclinical model for tracheal research due to its similar mechanical and dimensional characteristics to the human trachea. However, normative biomechanical properties have yet to be defined and it is one of the main reasons tracheal reconstruction has not succeeded in animal models at large scale. Variation and inaccurate measurement due to a lack of proper apparatus for mechanical tests further prevent determination of normative mechanical data of the trachea. The goal of this study was to overcome these shortcomings by designing the measuring apparatus using 3D-printing technology. Using this apparatus, we determined the normative biomechanical properties of the canine trachea. METHODS Whole tracheas were obtained from thirteen mongrel dogs. Biomechanical measurements were performed to determine the radial compressive strength and tensile strength of the intact trachea, and the elastic modulus of the tracheal cartilage. RESULTS Structural parameter data indicated the canine trachea to have inner-diameters similar to those of the human trachea and other widely used animal models. The compressive strength was 4.24N while the tensile strength was 29.96N. The elastic modulus of the cartilage portion of the trachea was 1.58N without showing a significant difference in value based on the location of the trachea. CONCLUSIONS This study delineates a comprehensive and foundational characterization of the biomechanical properties of both the intact and cartilage portion of the canine trachea. The parameters were in agreement with those of the human trachea, confirming the canine trachea to be an excellent preclinical model for tracheal research.
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Affiliation(s)
- Jennifer Sang-Jee Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Jonghyun Park
- Interdisciplinary Program for Bioengineering, Seoul National University Graduate School, 1 Gwanak-ro, Gwanak-gu Seoul 08826, Republic of Korea
| | - Dong-A Shin
- Interdisciplinary Program for Bioengineering, Seoul National University Graduate School, 1 Gwanak-ro, Gwanak-gu Seoul 08826, Republic of Korea
| | - Yoon-Jong Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Hee Chan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-Gu, Seoul, 03080 Republic of Korea; Department of Biomedical Engineering, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080 Republic of Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 1 Gwanak-ro, Gwanak-gu Seoul, 08826 Republic of Korea
| | - Jung Chan Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-Gu, Seoul, 03080 Republic of Korea; Department of Biomedical Engineering, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080 Republic of Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 1 Gwanak-ro, Gwanak-gu Seoul, 08826 Republic of Korea.
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080 Republic of Korea.
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Lee SS, Kim HD, Kim SHL, Kim I, Kim IG, Choi JS, Jeong J, Kim JH, Kwon SK, Hwang NS. Self-Healing and Adhesive Artificial Tissue Implant for Voice Recovery. ACS Appl Bio Mater 2018; 1:1134-1146. [DOI: 10.1021/acsabm.8b00349] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Seunghun S. Lee
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Hwan D. Kim
- School of Chemical and Biological Engineering, The Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Seung Hyun L. Kim
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Inseon Kim
- School of Chemical and Biological Engineering, The Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - In Gul Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Ji Suk Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Jiwoon Jeong
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Jung Hun Kim
- School of Chemical and Biological Engineering, The Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Seong Keun Kwon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 08826, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Nathaniel S. Hwang
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering, The Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
- BioMAX/N-Bio Institute, Seoul National University, Seoul 08826, Republic of Korea
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Kwon S, Lee SS, Sivashanmugam A, Kwon J, Kim SHL, Noh MY, Kwon SK, Jayakumar R, Hwang NS. Bioglass-Incorporated Methacrylated Gelatin Cryogel for Regeneration of Bone Defects. Polymers (Basel) 2018; 10:polym10080914. [PMID: 30960839 PMCID: PMC6403913 DOI: 10.3390/polym10080914] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 12/21/2022] Open
Abstract
Cryogels have recently gained interest in the field of tissue engineering as they inherently possess an interconnected macroporous structure. Considered to be suitable for scaffold cryogel fabrication, methacrylated gelatin (GelMA) is a modified form of gelatin valued for its ability to retain cell adhesion site. Bioglass nanoparticles have also attracted attention in the field due to their osteoinductive and osteoconductive behavior. Here, we prepare methacrylated gelatin cryogel with varying concentration of bioglass nanoparticles to study its potential for bone regeneration. We demonstrate that an increase in bioglass concentration in cryogel leads to improved mechanical property and augmented osteogenic differentiation of mesenchymal cells during in vitro testing. Furthermore, in vivo testing in mice cranial defect model shows that highest concentration of bioglass nanoparticles (2.5 w/w %) incorporated in GelMA cryogel induces the most bone formation compared to the other tested groups, as studied by micro-CT and histology. The in vitro and in vivo results highlight the potential of bioglass nanoparticles incorporated in GelMA cryogel for bone regeneration.
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Affiliation(s)
- Song Kwon
- School of Chemical and Biological Engineering, the Institute of Chemical Processes, Seoul National University, Seoul 08826, Korea.
| | - Seunghun S Lee
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 08826, Korea.
| | - A Sivashanmugam
- Center for Nanosciences and Molecular Medicine, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham, Kochi 682041, India.
| | - Janet Kwon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 08826, Korea.
| | - Seung Hyun L Kim
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 08826, Korea.
| | - Mi Yeon Noh
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 08826, Korea.
| | - Seong Keun Kwon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 08826, Korea.
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul 03080, Korea.
| | - R Jayakumar
- Center for Nanosciences and Molecular Medicine, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham, Kochi 682041, India.
| | - Nathaniel S Hwang
- School of Chemical and Biological Engineering, the Institute of Chemical Processes, Seoul National University, Seoul 08826, Korea.
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul 08826, Korea.
- BioMAX/N-Bio Institute, Seoul National University, Seoul 08826, Korea.
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Kim BH, Kwon SK, Hah J. Chemocauterization of second branchial cleft fistula using trichloroacetic acid: A preliminary report. Auris Nasus Larynx 2018; 45:143-146. [DOI: 10.1016/j.anl.2017.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
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Lim YS, Kim HB, Park JH, Cho CG, Park SW, Lee JS, Kim EJ, Kwon SK. Effects of excessive fibrin deposit and polylactide adhesion barrier on wound healing in thyroidectomy murine wound model. Head Neck 2018; 40:1207-1213. [PMID: 29385303 DOI: 10.1002/hed.25096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/21/2017] [Accepted: 01/10/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We hypothesize that excessive fibrin formation and inflammation induced by antiadhesive material, SurgiWrap (SW), would have an adverse effect on wound healing. It was evaluated by a thyroidectomy murine wound model. METHODS Excessive fibrin formation was induced by isthmectomy without hemostasis. Rats were allocated into isthmectomy with SurgiWrap (I+SW+), I+SW-, I-SW+, I-SW-, and isthmectomy after electrocautery for hemostasis (I+C+SW-). The SWs were placed on the superficial and visceral layers for gross and microscopic evaluation. RESULTS Microscopic examination showed collagen deposition occurred in the I-SW- sham group and at a higher level in I+C+SW-. The collagen deposition decreased in groups without SW with time but increased in groups with SW. Use of SW produced more inflammation and more collagen deposition. The I+SW + group developed the largest area of collagen deposition at 4 weeks and more collagen deposition than the I-SW + group. CONCLUSION The SW induced more collagen deposition increasing with time. The collagen deposition produced by SW was worsened by excessive fibrin formation and inflammation.
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Affiliation(s)
- Yun-Sung Lim
- Department of Otorhinolaryngology - Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, Korea
| | - Hee-Bok Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, Korea
| | - Joo Hyun Park
- Department of Otorhinolaryngology - Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, Korea
| | - Chang Gun Cho
- Department of Otorhinolaryngology - Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, Korea
| | - Seok-Won Park
- Department of Otorhinolaryngology - Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, Korea
| | - Jae Suk Lee
- Departments of Pathology, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, Korea
| | - Eo Jin Kim
- Departments of Pathology, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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45
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Kang KT, Koh YG, Son J, Kwon OR, Lee JS, Kwon SK. A computational simulation study to determine the biomechanical influence of posterior condylar offset and tibial slope in cruciate retaining total knee arthroplasty. Bone Joint Res 2018; 7:69-78. [PMID: 29330345 PMCID: PMC5805829 DOI: 10.1302/2046-3758.71.bjr-2017-0143.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Posterior condylar offset (PCO) and posterior tibial slope (PTS) are critical factors in total knee arthroplasty (TKA). A computational simulation was performed to evaluate the biomechanical effect of PCO and PTS on cruciate retaining TKA. Methods We generated a subject-specific computational model followed by the development of ± 1 mm, ± 2 mm and ± 3 mm PCO models in the posterior direction, and -3°, 0°, 3° and 6° PTS models with each of the PCO models. Using a validated finite element (FE) model, we investigated the influence of the changes in PCO and PTS on the contact stress in the patellar button and the forces on the posterior cruciate ligament (PCL), patellar tendon and quadriceps muscles under the deep knee-bend loading conditions. Results Contact stress on the patellar button increased and decreased as PCO translated to the anterior and posterior directions, respectively. In addition, contact stress on the patellar button decreased as PTS increased. These trends were consistent in the FE models with altered PCO. Higher quadriceps muscle and patellar tendon force are required as PCO translated in the anterior direction with an equivalent flexion angle. However, as PTS increased, quadriceps muscle and patellar tendon force reduced in each PCO condition. The forces exerted on the PCL increased as PCO translated to the posterior direction and decreased as PTS increased. Conclusion The change in PCO alternatively provided positive and negative biomechanical effects, but it led to a reduction in a negative biomechanical effect as PTS increased. Cite this article: K-T. Kang, Y-G. Koh, J. Son, O-R. Kwon, J-S. Lee, S. K. Kwon. A computational simulation study to determine the biomechanical influence of posterior condylar offset and tibial slope in cruciate retaining total knee arthroplasty. Bone Joint Res 2018;7:69–78. DOI: 10.1302/2046-3758.71.BJR-2017-0143.R1.
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Affiliation(s)
- K-T Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Y-G Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
| | - J Son
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - O-R Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
| | - J-S Lee
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
| | - S K Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
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Chung EJ, Jun DR, Kim DW, Han MJ, Kwon TK, Choi SW, Kwon SK. Prevention of polydimethylsiloxane microsphere migration using a mussel-inspired polydopamine coating for potential application in injection therapy. PLoS One 2017; 12:e0186877. [PMID: 29095854 PMCID: PMC5667927 DOI: 10.1371/journal.pone.0186877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/09/2017] [Indexed: 11/18/2022] Open
Abstract
The use of injectable bulking agents is a feasible alternative procedure for conventional surgical therapy. In this study, poly(dimethylsiloxane) (PDMS) microspheres coated with polydopamine (PDA) were developed as a potential injection agent to prevent migration in vocal fold. Uniform PDMS microspheres are fabricated using a simple fluidic device and then coated with PDA. Cell attachment test reveals that the PDA-coated PDMS (PDA-PDMS) substrate favors cell adhesion and attachment. The injected PDA-PDMS microspheres persist without migration on reconstructed axial CT images, whereas, pristine PDMS locally migrates over a period of 12 weeks. The gross appearance of the implants retrieved at 4, 8, 12 and 34 weeks indicates that the PDA-PDMS group maintained their original position without significant migration until 34 weeks after injection. By contrast, there is diffuse local migration of the pristine PDMS group from 4 weeks after injection. The PDA-coated PDMS microspheres can potentially be used as easily injectable, non-absorbable filler without migration.
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Affiliation(s)
- Eun-Jae Chung
- Department of Otorhinolaryngology, College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dae-Ryong Jun
- Department of Biotechnology, The Catholic University of Korea, Gyeonggi-do, Korea
| | - Dong-Wook Kim
- Department of Otorhinolaryngology, College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Mi-Jung Han
- Department of Otorhinolaryngology, College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology, College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung-Wook Choi
- Department of Biotechnology, The Catholic University of Korea, Gyeonggi-do, Korea
- * E-mail: (SKK); (SWC)
| | - Seong Keun Kwon
- Department of Otorhinolaryngology, College of Medicine, Seoul National University Hospital, Seoul, Korea
- * E-mail: (SKK); (SWC)
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Ahn HJ, Khalmuratova R, Park SA, Chung EJ, Shin HW, Kwon SK. Serial Analysis of Tracheal Restenosis After 3D-Printed Scaffold Implantation: Recruited Inflammatory Cells and Associated Tissue Changes. Tissue Eng Regen Med 2017; 14:631-639. [PMID: 30603516 DOI: 10.1007/s13770-017-0057-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/04/2017] [Accepted: 04/17/2017] [Indexed: 02/07/2023] Open
Abstract
Tracheal restenosis is a major obstacle to successful tracheal replacement, and remains the greatest challenge in tracheal regeneration. However, there have been no detailed investigations of restenosis. The present study was performed to analyze the serial changes in recruited inflammatory cells and associated histological changes after tracheal scaffold implantation. Asymmetrically porous scaffolds, which successfully prevented tracheal stenosis in a partial trachea defect model, designed with a tubular shape by electrospinning and reinforced by 3D-printing to reconstruct 2-cm circumferential tracheal defect. Serial rigid bronchoscopy, micro-computed tomography, and histology [H&E, Masson's Trichrome, IHC against α-smooth muscle actin (α-SMA)] were performed 1, 4, and 8 weeks after transplantation. Progressive stenosis developed especially at the site of anastomosis. Neutrophils were the main inflammatory cells recruited in the early stage, while macrophage infiltration increased with time. Recruitment of fibroblasts peaked at 4 weeks and deposition of α-SMA increased from 4 weeks and was maintained through 8 weeks. During the first 8 weeks post-transplantation, neutrophils and macrophages played significant roles in restenosis of the trachea. Antagonists to these would be ideal targets to reduce restenosis and thus play a pivotal role in successful tracheal regeneration.
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Affiliation(s)
- Hee-Jin Ahn
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
| | - Roza Khalmuratova
- 2Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, 03080 Korea
| | - Su A Park
- 3Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Gajeongbuk-ro 156, Daejeon, 34103 Korea
| | - Eun-Jae Chung
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
| | - Hyun-Woo Shin
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Korea.,2Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, 03080 Korea.,4Department of Biomedical Sciences, Seoul National University Graduate School, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Korea.,5Cancer Research Institute and Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
| | - Seong Keun Kwon
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
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Ock CY, Kim S, Keam B, Kim S, Ahn YO, Chung EJ, Kim JH, Kim TM, Kwon SK, Jeon YK, Jung KC, Kim DW, Wu HG, Sung MW, Heo DS. Changes in programmed death-ligand 1 expression during cisplatin treatment in patients with head and neck squamous cell carcinoma. Oncotarget 2017; 8:97920-97927. [PMID: 29228662 PMCID: PMC5716702 DOI: 10.18632/oncotarget.18542] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/04/2017] [Indexed: 12/31/2022] Open
Abstract
Programmed death-ligand 1 (PD-L1) expression is regarded as a predictive marker for anti-PD-1/PD-L1 therapy. The purpose of study was to explore the changes in PD-L1 expression in head and neck squamous cell carcinoma (HNSCC) during treatment. Paired HNSCC tissues prior to and after cisplatin-based treatment were evaluated to determine PD-L1 protein expression by immunohistochemistry. Among the 35 HNSCC patient samples, PD-L1 expression status changed after treatment in 37.1% (13/35) of samples. Among the 13 patients whose baseline PD-L1 was negative, PD-L1 expression was increased in 9 cases (69.2%) and remained negative in 4 cases (30.8%, P = 0.003). Patients exposed to cisplatin generally showed PD-L1 up-regulation (83.3%, P = 0.037) compared to those not exposed to cisplatin (57.1%, P = 0.072). To validate these findings in vitro, changes in PD-L1 expression in HNSCC cell lines (Detroit-562, PCI-13, SNU-1041, SNU-1066, SNU-1076, and FaDu) were analyzed by western blotting and flow cytometry after treatment with cisplatin and interferon-gamma. In HNSCC cell lines, PD-L1 expression was significantly up-regulated after cisplatin, along with phosphor-MAPK/ERK kinase up-regulation. In conclusion, PD-L1 expression in HNSCC may be altered during cisplatin treatment, activating the MAPK/ERK kinase pathway.
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Affiliation(s)
- Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sehui Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Soyeon Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Oon Ahn
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Kyeong Chun Jung
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Lee DY, Kim HB, Shim IK, Kanai N, Okano T, Kwon SK. Treatment of chemically induced oral ulcer using adipose-derived mesenchymal stem cell sheet. J Oral Pathol Med 2016; 46:520-527. [PMID: 27805722 DOI: 10.1111/jop.12517] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study investigated the effects of mesenchymal stem cell (MSC) sheet transplantation on healing of chemically induced oral ulceration in a rabbit animal model. METHODS Oral mucosal ulcers were induced by topical application of filter paper soaked with 70% acetic acid to the anterior gingiva and buccal mucosa of 12 New Zealand white rabbits. The animals were randomly assigned to two groups: with (treatment group, n = 6) or without (control group, n = 6) cell sheets applied to ulcers. Gross findings were sequentially evaluated, and histologic examination was performed on day 7. RESULTS Based on gross inspection, ulceration resolved before day 5 in the treatment group; however, in the control group, healing was incomplete on day 7. In the treatment group, the total area of the ulcer decreased significantly from day 2 to day 5 (P < 0.001) and from day 5 to day 7 (P = 0.020), whereas the area decreased significantly from day 5 to day 7 in the control group (P < 0.001). Histologic and immunofluorescence examination revealed full-thickness mucosa healing and complete basal cell coverage in the treatment group; in contrast, only partial healing was observed on day 7 in the control group. CONCLUSIONS Cell sheet technology using MSC can be an alternative treatment for oral ulcerations in that it can decrease healing time without invasive properties.
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Affiliation(s)
- Doh Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Anam Hospital, Korea University Medical Center, Seoul, Korea
| | - Hee-Bok Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - In Kyoung Shim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Nobuo Kanai
- Institute of Advanced Biomedical Engineering and Science, TWIns, Tokyo Women's Medical University, Tokyo, Japan
| | - Teruo Okano
- Institute of Advanced Biomedical Engineering and Science, TWIns, Tokyo Women's Medical University, Tokyo, Japan
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University Hospital, Seoul, Korea.,Medical Research Center, Seoul National University Hospital, Seoul, Korea
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50
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Kim DW, Kim EJ, Kim EN, Sung MW, Kwon TK, Cho YW, Kwon SK. Human Adipose Tissue Derived Extracellular Matrix and Methylcellulose Hydrogels Augments and Regenerates the Paralyzed Vocal Fold. PLoS One 2016; 11:e0165265. [PMID: 27768757 PMCID: PMC5074505 DOI: 10.1371/journal.pone.0165265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/07/2016] [Indexed: 12/15/2022] Open
Abstract
Vocal fold paralysis results from various etiologies and can induce voice changes, swallowing complications, and issues with aspiration. Vocal fold paralysis is typically managed using injection laryngoplasty with fat or synthetic polymers. Injection with autologous fat has shown excellent biocompatibility. However, it has several disadvantages such as unpredictable resorption rate, morbidities associated with liposuction procedure which has to be done in operating room under general anesthesia. Human adipose-derived extracellular matrix (ECM) grafts have been reported to form new adipose tissue and have greater biostability than autologous fat graft. Here, we present an injectable hydrogel that is constructed from adipose tissue derived soluble extracellular matrix (sECM) and methylcellulose (MC) for use in vocal fold augmentation. Human sECM derived from adipose tissue was extracted using two major steps—ECM was isolated from human adipose tissue and was subsequently solubilized. Injectable sECM/MC hydrogels were prepared by blending of sECM and MC. Sustained vocal fold augmentation and symmetric vocal fold vibration were accomplished by the sECM/MC hydrogel in paralyzed vocal fold which were confirmed by laryngoscope, histology and a high-speed imaging system. There were increased number of collagen fibers and fatty granules at the injection site without significant inflammation or fibrosis. Overall, these results indicate that the sECM/MC hydrogel can enhance vocal function in paralyzed vocal folds without early resorption and has potential as a promising material for injection laryngoplasty for stable vocal fold augmentation which can overcome the shortcomings of autologous fat such as unpredictable duration and morbidity associated with the fat harvest.
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Affiliation(s)
- Dong Wook Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Ji Kim
- Department of Chemical Engineering, Hanyang University, Ansan, Gyeonggi-do 426–791, Republic of Korea
| | - Eun Na Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung Whun Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Woo Cho
- Department of Chemical Engineering, Hanyang University, Ansan, Gyeonggi-do 426–791, Republic of Korea
- * E-mail: (SKK); (YWC)
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail: (SKK); (YWC)
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