Phenotypic characterization of pre-harvest sprouting resistance mutants generated by the CRISPR/Cas9-geminiviral replicon system in rice

Pre-harvest sprouting is a critical phenomenon involving germination of seeds in the mother plant before harvest under relative humid conditions and reduced dormancy. In this paper, we generated HDR mutant lines with one region SNP (C/T) and an insertion of 6 bp (GGT/GGTGGCGGC) in OsERF1 genes for pre-harvest sprouting (PHS) resistance using CRISPR/Cas9 and a geminiviral replicon system. The incidence of HDR was 2.6% in transformed calli. T1 seeds were harvested from 12 HDR-induced calli and named ERF1-hdr line. Molecular stability, key agronomic properties, physiological properties, and biochemical properties of target genes in the ERF1-hdr line were investigated for three years. The ERF1-hdr line showed significantly enhanced seed dormancy and pre-harvest sprouting resistance. qRT-PCR analysis suggested that enhanced ABA signaling resulted in a stronger phenotype of PHS resistance. These results indicate that efficient HDR can be achieved through SNP/InDel replacement using a single and modular configuration applicable to different rice targets and other crops. This work demonstrates the potential to replace all genes with elite alleles within one generation and greatly expands our ability to improve agriculturally important traits. [BMB Reports 2024; 57(2): 79-85].

The Feasibility of Fast, Four-Dimensional Computed Tomography-Based O-Ring Linac Plans for Stereotactic Body Radiotherapy in Patients with Poor Performance Status

PURPOSE/OBJECTIVE(S)

As patients with poor performance status cannot endure long treatment times, it can lead to unplanned and prolonged radiation treatment or discontinuation of treatment. Moreover, prolonged radiation treatment appears to negatively affect survival for patients. We aimed to verify the feasibility of fast 4DCT-based O-ring linear accelerator (LINAC) treatment in lung 4D stereotactic body radiotherapy (SBRT).

MATERIALS/METHODS

This study included data of 38 patients who received lung 4D-SBRT. Gating20-70% plans were based on 4DCT data obtained at phase values ranging from 20-70% using a C-arm LINAC. Non-GatingFB plans were retrospectively established based on 4DCT data obtained at phase values of 0-90% using an O-ring LINAC. The prescribed dose of 4,800 cGy was delivered to PTV in four fractions. The conformity index (CI), homogeneity index (HI), and gradient measurement (GM) of the PTV were analyzed to compare dosimetric data between Gating20-70% and Non-GatingFB plans. Organs at risks (OARs) were analyzed in accordance with the RTOG 0915 protocol. Treatment delivery time and total monitor units (MU) were analyzed to compare the efficiency of treatment delivery. Statistical comparisons were performed using the Wilcoxon signed-rank test (p<0.05).

RESULTS

For the PTV, there was no significant difference in the CI or HI between Gating20-70% and Non-GatingFB plans (CI: 1.337±0.137, 1.335±0.174, HI: 0.939±0.015, 0.939±0.016, all at p>0.05). However, there was a significant difference in GM between Gating20-70% and Non-GatingFB plan (1.528±0.206 cm, 1.381±0.222 cm, p<0.001). For OARs, all plans met the criteria for dose constraint. There was a significant difference between Gating20-70% and Non-GatingFB plans except in the spinal cord. In particular, D1000cc and D1500cc values for the ipsilateral lung for Gating20-70% plans were 31.6% and 59.9% lower than those for Non-GatingFB plans (D1000cc: 50.780±132.061 cGy, 34.755±102.480 cGy, p<0.001, D1500cc: 6.641±14.598 cGy, 2.666±7.926 cGy, p<0.001). Treatment delivery time was 92% longer for Gating20-70% plans than for Non-GatingFB plans (5.0±0.4 min, 9.6±3.3 min, p = 0.043). The total MU value for Gating20-70% plans was 9.6% higher than that for Non-GatingFB plans (3665.8±230.7, 4016±236.9, p = 0.039).

CONCLUSION

When compared to OARs both plans were acceptable per RTOG-0915 protocol, but significant differences were between Non-GatingFB and Gating20-70% plans. However, treatment delivery time of Non-GatingFB plans decreased by 47.9% than Gating20-70% plans. We verified the feasibility of fast 4DCT-based O-ring LINAC treatment for patients who cannot endure long treatment times due to poor performance status in lung 4D-SBRT. In further study, we will analyze dosimetric differences and treatment delivery efficiency considering tumor motion according to tumor location.

Differences in the predicted nasoseptal flap length among races: A propensity score matching analysis

OBJECTIVES

We compared the lengths of a nasoseptal flap (NSF) and skull base according to race, age, and sex.

METHODS

We performed paranasal sinus computed tomography in 19,961 adult patients between 2003 and 2022. The race of the patients was East Asian (n = 71), Caucasian (n = 71), or Middle Eastern (n = 71). The expected lengths of the NSF and anterior skull base defect were measured and analyzed according to race, age, and sex.

RESULTS

Compared with Caucasians and Middle Easterners, East Asians had a shorter NSF length (p < 0.001) and lower ratio of the expected NSF length to the expected defect length (p < 0.001). There was no difference in the values among age groups. The expected NSF length was longer, and the ratio of the expected NSF length to the expected defect length was higher, in males than females (p < 0.001 for both).

CONCLUSIONS

East Asians and females had a shorter NSF length and lower ratio of expected NSF to surgical defect lengths after anterior skull base reconstruction compared with the other races and with males, respectively. Anatomical differences should be considered when long NSF lengths are required, such as for anterior skull base reconstruction.

Hematometra Due to Cervical Stenosis in a Postmenopausal Woman with Incidental Ovarian Steroid Cell Tumor: A Case Report

Vaginal bleeding is reported among 4%-11% of postmenopausal women. Hematometra is commonly associated with cervical stenosis due to senile atrophy, radiotherapy, or a uterine neoplastic lesion in women of postmenopausal age. Ovarian steroid cell tumor is a rare hormone-secreting tumor subtype accounting for approximately 0.1% of all ovarian tumors. Here we report a case of hematometra in a postmenopausal woman with high estrogen levels who was later diagnosed with a steroid cell tumor.

Application of the Team Emergency Assessment Measure for Prehospital Cardiopulmonary Resuscitation

Introduction: Communication and teamwork are critical for ensuring patient safety, particularly during prehospital cardiopulmonary resuscitation (CPR). The Team Emergency Assessment Measure (TEAM) is a tool applicable to such situations. This study aimed to validate the TEAM efficiency as a suitable tool even in prehospital CPR. Methods: A multi-centric observational study was conducted using the data of all non-traumatic out-of-hospital cardiac arrest patients aged over 18 years who were treated using video communication-based medical direction in 2018. From the extracted data of 1494 eligible patients, 67 sample cases were randomly selected. Two experienced raters were assigned to each case. Each rater reviewed 13 or 14 videos and scored the TEAM items for each field cardiopulmonary resuscitation performance. The internal consistency, concurrent validity, and inter-rater reliability were measured. Results: The TEAM showed high reliability with a Cronbach’s alpha value of 0.939, with a mean interitem correlation of 0.584. The mean item–total correlation was 0.789, indicating significant associations. The mean correlation coefficient between each item and the global score range was 0.682, indicating good concurrent validity. The mean intra-class correlation coefficient was 0.804, indicating excellent agreement. Discussion: The TEAM can be a valid and reliable tool to evaluate the non-technical skills of a team of paramedics performing CPR.

Changes in the Sphenoid Bone Encountered During the Endoscopic Endonasal Transsphenoidal Approach

OBJECTIVES

We estimated volume changes in the posterior bony wall of the sphenoid sinus, as well as alterations in nasal function (including olfactory function and subjective symptoms), after sphenoid mucosal repositioning using the endoscopic endonasal transsphenoidal approach (EETSA).

METHODS

During 2010 and 2021, 13 patients underwent sphenoid mucosal repositioning during EETSA, while 24 patients (the control group) did not. Pre- and postoperative paranasal sinus computed tomography and the Mimics program were used to evaluate three-dimensional changes in the posterior wall of the sphenoid sinus. All patients underwent the Connecticut Chemosensory Clinical Research Center (CCCRC) test, the Cross-Cultural Smell Identification Test (CCSIT), Nasal Obstruction Symptoms Evaluation (NOSE), the Sino-Nasal Outcome Test-20 (SNOT-20), and visual analog scale (VAS) evaluation.

RESULTS

The increase in the volume of the posterior wall of the sphenoid sinus after surgery was objectively smaller in the sphenoid mucosal repositioning group than in the control group (P = .046). However, this did not affect olfactory function (as revealed by the CCCRC test or the CCSIT) or subjective symptoms (as revealed by the NOSE, SNOT-20, and VAS scores) (all P > .05).

CONCLUSION

Surgical closure via sphenoid mucosal repositioning during EETSA reduces the volume of the posterior wall of the sphenoid sinus and facilitates re-operation. We suggest that sphenoid mucosal repositioning is appropriate during EETSA.

LEVEL OF EVIDENCE

4 Laryngoscope, 2022.

Nicotinamide Riboside Vitamin B3 Mitigated C26 Adenocarcinoma-Induced Cancer Cachexia

Nicotinamide riboside (NR), vitamin B3, is a substrate for nicotinamide adenine dinucleotide (NAD⁺)–consuming enzymes and is a coenzyme for hydride-transfer enzymes, including adenosine diphosphate (ADP)–ribose transferases, poly (ADP-ribose) polymerases, cADP-ribose synthases, and sirtuins, which play a central role in the aging process, neurodegenerative processes, and myopathy. Since cancer cachexia is a disease condition presenting with weight loss, skeletal muscle atrophy, and loss of adipose tissue in patients with advanced cancer, we hypothesized that NR intake could ameliorate sarcopenia. In this study, we investigated whether preemptive administration of NR ameliorated C26 adenocarcinoma–induced cancer cachexia and explored anti-cachexic mechanisms focused on the changes in muscle atrophy, cachexic inflammation, and catabolic catastrophe. Dietary intake of the NR-containing pellet diet significantly attenuated cancer cachexia in a mouse model. Starting with significant inhibition of cachexic factors, tumor necrosis factor alpha, and interleukin-6, NR significantly inhibited muscle-specific ubiquitin-proteasome ligases, such as atrogin-1, muscle RING-finger protein-1 (MuRF-1), mitofusin-2, and peroxisome proliferator–activated receptor gamma coactivator-1-alpha (PCG-1α). Significant inhibition of epididymal fat lipolysis was noted with significant inhibition of adipose triglyceride lipase (ATGL) gene. Furthermore, NR administration significantly increased the levels of crucial enzymes involved in the biosynthesis of NAD⁺ and nicotinamide phosphoribosyl transferase and significantly inhibited the NAD⁺-sensitive deacetylase sirtuin 1 (SIRT1). Preemptive intake of NR in patients vulnerable to cachexia can be a preemptive option to ameliorate cancer cachexia.

Ribosomal protein S3 associates with the TFIIH complex and positively regulates nucleotide excision repair

In mammalian cells, the bulky DNA adducts caused by ultraviolet radiation are mainly repaired via the nucleotide excision repair (NER) pathway; some defects in this pathway lead to a genetic disorder known as xeroderma pigmentosum (XP). Ribosomal protein S3 (rpS3), a constituent of the 40S ribosomal subunit, is a multi-functional protein with various extra-ribosomal functions, including a role in the cellular stress response and DNA repair-related activities. We report that rpS3 associates with transcription factor IIH (TFIIH) via an interaction with the xeroderma pigmentosum complementation group D (XPD) protein and complements its function in the NER pathway. For optimal repair of UV-induced duplex DNA lesions, the strong helicase activity of the TFIIH complex is required for unwinding damaged DNA around the lesion. Here, we show that XP-D cells overexpressing rpS3 showed markedly increased resistance to UV radiation through XPD and rpS3 interaction. Additionally, the knockdown of rpS3 caused reduced NER efficiency in HeLa cells and the overexpression of rpS3 partially restored helicase activity of the TFIIH complex of XP-D cells in vitro. We also present data suggesting that rpS3 is involved in post-excision processing in NER, assisting TFIIH in expediting the repair process by increasing its turnover rate when DNA is damaged. We propose that rpS3 is an accessory protein of the NER pathway and its recruitment to the repair machinery augments repair efficiency upon UV damage by enhancing XPD helicase function and increasing its turnover rate.

A socio-technological model of search information divide in US cities

Purpose

The purpose of the current study is to theorize and apply a socio-technological model – the powerful influence of social determinants in conditioning the effects of information attention on social outcomes. Fundamentally, this study is motivated by the idea that the social determinants of information flow can be used as a predictive tool to inform public socio-policy decisions.

Design/methodology/approach

This study draws upon digital disparity literature and uses publicly available Google search queries in exploring online information attention and its relationships to the HIV/AIDS diffusion in US cities. This study’s secondary data collected from extant sources is used to draw attention to a holistic urban ecology under which online search attention represents the variation of information access at the aggregate level.

Findings

The main finding shows that online information attention, as indicated by search trend, is far from being a simple predictor, but operates in complex interactions with existing social environments. A bivariate correlation between AIDS information search and AIDS diffusion rate was found to be significant. However, predictive multivariate models displayed robust effects of social contextual variables, such as income level and racial composition of cities, in moderating the effect of online search information flow.

Practical implications

The importance of these insights is discussed for reducing socio-health disparities at the macro-social level, and policymakers and health administrators are recommended to incubate supportive online infrastructure as an effective preventive measure at the time of a crisis.

Originality/value

The unique contribution of this study is the premise that looks at the aggregate-ecological contour of cities within which the potential benefits of information occur, instead of examining the isolated function of mediated information per se. In this vein, online information search, in lieu of the exposure to mass media message that is often measured via self-reported items, is a particularly unique and fruitful area of future inquiry that this study promotes.

Revaprazan prevented indomethacin-induced intestinal damages by enhancing tight junction related mechanisms

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed medications for alleviating pain and inflammation but may cause gastrointestinal tract damage. Proton pump inhibitors (PPI) prevent NSAID-induced gastric damage but may aggravate intestinal damage via dysbiosis and intestinal permeability alteration. Currently, there is growing interest regarding the influence of potassium competitive acid blockers (PCAB) on NSAID-induced enteropathy. Here, we investigated the relative changes in indomethacin-induced enteropathy by combining indomethacin with pantoprazole (as PPI) or revaprazan (as PCAB). We examined intestinal permeability-related molecular changes in in vitro Caco-2 cell models and in an in vivo indomethacin-induced enteropathy rat model. Indomethacin alone or in combination with pantoprazole significantly increased relative lucifer yellow dye flux and decreased relative trans-epithelial electrical resistance and tight junction protein (TJP) expression compare to normal cells. In contrast, indomethacin combined with revaprazan significantly preserved TJPs compare to indomethacin-treated cells. MLC phosphorylation, Rho activation, and ERK activation responsible for TJP were significantly increased by indomethacin alone or a combination of indomethacin and pantoprazole but not by a combination of indomethacin and revaprazan. Intestinal damage scores significantly increased with indomethacin and pantoprazole combination but not with indomethacin and revaprazan combination. Indomethacin and pantoprazole combination significantly activated Rho-GTPase, p-MLC, and p-ERK but significantly decreased TJP expression. However, indomethacin and revaprazan combination significantly preserved TJPs and inactivated Rho-GTPase, MLC, and ERK. Hence, revaprazan rather than PPIs should be co-administered with NSAIDs to mitigate NSAID-induced intestinal damage.

Machine learning-based diagnostic method of pre-therapeutic 18F-FDG PET/CT for evaluating mediastinal lymph nodes in non-small cell lung cancer

OBJECTIVES

We aimed to find the best machine learning (ML) model using ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for evaluating metastatic mediastinal lymph nodes (MedLNs) in non-small cell lung cancer, and compare the diagnostic results with those of nuclear medicine physicians.

METHODS

A total of 1329 MedLNs were reviewed. Boosted decision tree, logistic regression, support vector machine, neural network, and decision forest models were compared. The diagnostic performance of the best ML model was compared with that of physicians. The ML method was divided into ML with quantitative variables only (MLq) and adding clinical information (MLc). We performed an analysis based on the ¹⁸F-FDG-avidity of the MedLNs.

RESULTS

The boosted decision tree model obtained higher sensitivity and negative predictive values but lower specificity and positive predictive values than the physicians. There was no significant difference between the accuracy of the physicians and MLq (79.8% vs. 76.8%, p = 0.067). The accuracy of MLc was significantly higher than that of the physicians (81.0% vs. 76.8%, p = 0.009). In MedLNs with low ¹⁸F-FDG-avidity, ML had significantly higher accuracy than the physicians (70.0% vs. 63.3%, p = 0.018).

CONCLUSION

Although there was no significant difference in accuracy between the MLq and physicians, the diagnostic performance of MLc was better than that of MLq or of the physicians. The ML method appeared to be useful for evaluating low metabolic MedLNs. Therefore, adding clinical information to the quantitative variables from ¹⁸F-FDG PET/CT can improve the diagnostic results of ML.

KEY POINTS

• Machine learning using two-class boosted decision tree model revealed the highest value of area under curve, and it showed higher sensitivity and negative predictive values but lower specificity and positive predictive values than nuclear medicine physicians. • The diagnostic results from machine learning method after adding clinical information to the quantitative variables improved accuracy significantly than nuclear medicine physicians. • Machine learning could improve the diagnostic significance of metastatic mediastinal lymph nodes, especially in mediastinal lymph nodes with low 18F-FDG-avidity.

Dietary intake of walnut prevented Helicobacter pylori-associated gastric cancer through rejuvenation of chronic atrophic gastritis

The fact that Fat-1 transgenic mice producing n-3 polyunsaturated fatty acids via overexpressed 3-desaturase significantly mitigated Helicobacter pylori (H. pylori)-associated gastric tumorigenesis through rejuvenation of chronic atrophic gastritis (CAG) led us to study whether dietary intake of walnut plentiful of n-3 PUFAs can be nutritional intervention to prevent H. pylori-associated gastric cancer. In our model that H. pylori-initiated, high salt diet-promoted gastric carcinogenesis, pellet diet containing 100 mg/kg and 200 mg/kg walnut was administered up to 36 weeks. As results, control mice (24 weeks) developed significant chronic CAG, in which dietary walnuts significantly ameliorated chronic atrophic gastritis. Expressions of COX-2/PGE₂/NF-κB/c-Jun, elevated in 24 weeks control group, were all significantly decreased with walnut (p<0.01). Tumor suppressive enzyme, 15-PGDH, was significantly preserved with walnut. Control mice (36 weeks) all developed significant tumors accompanied with severe CAG. However, significantly decreased tumorigenesis was noted in group treated with walnuts, in which expressions of COX-2/PGE₂/NF-κB/IL-6/STAT3, all elevated in 36 weeks control group, were significantly decreased with walnut. Defensive proteins including HO-1, Nrf2, and SOCS-1 were significantly increased in walnut group. Proliferative index as marked with Ki-67 and PCNA was significantly regulated with walnut relevant to 15-PGDH preservation. Conclusively, walnut can be an anticipating nutritional intervention against H. pylori.

Characteristics and outcomes of public bath-related out-of-hospital cardiac arrests in South Korea

Objective

To analyze the differences in characteristics and outcomes between public bath (PB)-related and non-PB-related out-of-hospital cardiac arrest (OHCA) patients in South Korea.

Methods

We performed a retrospective observational analysis of collected data from the Smart Advanced Cardiac Life Support (SALS) registry between September 2015 and December 2018. We included adult OHCA patients (aged >18 years) with presumed OHCA of non-traumatic etiology who were attended by dispatched emergency medical services. SALS is a field advanced life support with smartphone-based direct medical direction. The primary outcome was the survival to discharge rate measured at the time of discharge.

Results

Of 38,995 cardiac arrest patients enrolled in the SALS registry, 11,889 were included in the final analysis. In total, 263 OHCAs occurred in PBs. Male sex and bystander cardiopulmonary resuscitation proportions appeared to be higher among PB patients than among non-PB patients. Percentages for shockable rhythm, witnessed rate, and number of underlying disease were lower in the PB group than in the non-PB group. Prehospital return of spontaneous circulation (11.4% vs. 19.5%, P=0.001), survival to discharge (2.3% vs. 9.9%, P<0.001), and favorable neurologic outcome (1.9% vs. 5.8%, P=0.007) in PB patients were significantly poorer than those in non-PB patients.

Conclusion

Patient characteristics and emergency medical services factors differed between PB and non-PB patients. All outcomes of PB-related OHCA were poorer than those of non-PB-related OHCA. Further treatment strategies should be developed to improve the outcomes of PB-related cardiac arrest.

Low free T3 to free T4 ratio was associated with low muscle mass and impaired physical performance in community-dwelling aged population

In aged population, the association of thyroid hormones on physical performance, especially within their normal range, has yet to be elucidated. In this study, individuals with low serum free T3/free T4 were likely to have low muscle mass and impaired physical performance.

PURPOSE

We aimed to evaluate the associations of muscle mass, strength, and physical performance with thyroid hormone in an aged euthyroid population from a community-based cohort.

METHODS

We examined 918 men aged over 60 years and 1215 postmenopausal women from the Ansung cohort study. Appendicular skeletal muscle mass divided by square of height (ASM/ht²) was used as the muscle mass index. Hand grip strength was measured using a hydraulic dynamometer. Physical performance was assessed using the short physical performance battery (SPPB).

RESULTS

Participants with higher tertiles of free T3 and free T3/free T4 were younger and had higher ASM/ht², stronger hand grip strength, and higher SPPB scores than those in the lower tertiles. In adjusted models, men within higher tertiles of free T3 had higher ASM/ht² compared with those within lower tertiles (p = 0.033), whereas subjects with higher tertiles of free T4 had lower ASM/ht² compared with those within lower tertiles (p = 0.043). Subjects within higher tertiles of free T3/free T4 had higher ASM/ht² (p < 0.001) and better physical performance (p = 0.048) than those within lower tertiles after adjustments. However, free T3, free T4, or free T3/free T4 was not related to hand grip strength after adjustment for covariates.

CONCLUSION

Our results thus indicate that in an aged euthyroid population, low serum free T3/free T4 was a better index for low muscle mass and impaired physical performance than serum free T3 or free T4 alone.

Survival and Rearrest in out-of-Hospital Cardiac Arrest Patients with Prehospital Return of Spontaneous Circulation: A Prospective Multi-Regional Observational Study

OBJECTIVE

We aimed to determine the factors associated with rearrest after prehospital return of spontaneous circulation (ROSC) and examine the factors associated with survival despite rearrest.

METHODS

We conducted a prospective multi-regional observational study of out-of-hospital cardiac arrest (OHCA) patients between August 2015 and July 2016. Patients received prehospital advanced cardiovascular life support performed by emergency medical technicians (EMTs). EMTs were directly supervised by medical directors (physicians) via real-time smartphone video calls [Smart Advanced Life Support (SALS)]. The study participants were categorized into rearrest (+) and rearrest (-) groups depending on whether rearrest occurred after prehospital ROSC. After rearrest, patients were further classified as survivors or non-survivors at discharge.

RESULTS

SALS was performed in 1,711 OHCA patients. Prehospital ROSC occurred in 345 patients (20.2%); of these patients, 189 (54.8%) experienced rearrest [rearrest (+) group] and 156 did not experience rearrest [rearrest (-) group]. Multivariate analysis showed that a longer interval from collapse to first prehospital ROSC was independently associated with rearrest [odds ratio (OR) 1.081; 95% confidence interval (CI) 1.050-1.114]. The presence of an initial shockable rhythm was independently associated with survival after rearrest (OR 6.920; 95% CI 2.749-17.422). As a predictor of rearrest, the interval from collapse to first prehospital ROSC (cut-off: 24 min) had a sensitivity of 77% and a specificity of 54% (AUC = 0.715 [95% CI 0.661-0.769]).

CONCLUSIONS

A longer interval from collapse to first prehospital ROSC was associated with rearrest, and an initial shockable rhythm was associated with survival despite the occurrence of rearrest. Emergency medical service providers and physicians should be prepared to deal with rearrest when pulses are obtained late in the resuscitation.

The ontology of digital asset after death: policy complexities, suggestions and critique of digital platforms

Purpose

The digitization of the life has brought complexities associated with addressing digital life after one’s death. This paper aims to investigate the two related issues of the privacy and property of postlife digital assets.

Design/methodology/approach

The understanding of digital assets has not been fully unpacked largely due to the current policy complexities in accessing and obtaining digital assets at death. This paper calls critical attention to the importance of respecting user rights in digital environments that currently favor service providers’ interests.

Findings

It is argued that there are ethical blind spots when protecting users’ rights, given no ontological difference between a person’s digital beings and physical existence. These derive from the restrictive corporate terms and ambiguous conditions drafted by digital service providers.

Originality/value

Fundamentally, the transition to the big data era, in which the collection, use and dissemination of digital activities became integral part of the ontology, poses new challenges to privacy and property rights after death.

BPC157 as Potential Agent Rescuing from Cancer Cachexia

Cancer cachexia, one of the metabolic syndromes caused by cancer, is a devastating and miserable condition encountered in more than 50% of terminal cancer patients presenting with significant weight loss associated with skeletal muscle atrophy and fat loss. Though cachexia may account for up to 20% of cancer deaths, no significant treatment is still lacking and is of urgent unmet medical need in cancer treatment. Therefore, understanding the underlying molecular mechanisms is essential for anticipating therapeutic approaches. Since the primary events driving cachexia are mediated via either the central nervous system relatedor inflammation related-anorexia, hypoanabolism, and hypercatabolism, therapy usually targets nutritional support to compensate reduced food intake along with some anti-inflammatory agents to cover specific inflammation-related metabolic derangement, and encourages exercise to supplement reduced physical activity, but all proven to be not so effective so far. Therefore, combination therapies such as a standard multi-modal package including an anorexic agent, megestrol acetate, and anti-inflammatory agent coupled with the development of potential novel therapeutics promise a new era in rescuing patients from cancer cachexia. In this review, we propose the potential application of BPC157, one of the active cytoprotective agents isolated from gastric juices for cancer cachexia. Before clinical trial, we introduced the evidence showing BPC157 rescued from cancer cachexia supported with explored mode of actions.

P3617Systolic blood pressure, glycemic control and clinical outcome in diabetic patients with acute myocardial infarction

Background

Recent blood pressure guidelines recommend intensive blood pressure control in diabetic patients with cardiovascular disease.

Purpose

We sought to investigate combined impact of intensive blood glucose lowering and blood pressure control on clinical outcome in diabetic patients with acute myocardial infarction (AMI) has not been fully investigated yet.

Method

Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database included 12,179 patients (9,046 men; mean age = 63.6±12.6 year-old) who were discharged alive. Among them, 3,430 (28.2%) had a diabetes mellitus (DM). MACCEs were defined as a composition of all cause death, non-fatal MI, repeat revascularizations including repeated percutaneous coronary intervention and coronary bypass grafting, cerebrovascular accident and rehospitalizations at 1 year. This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.

Result

We determined cut-off value of discharge systolic blood pressure (SBP) to predict 1-year MACCE in DM and non-DM patients. Discharge SBP of less than 130mmHg was associated with a lower MACCE at 1 year compared to SBP level of 130mmHg or greater (10.8% versus 15.4%; log-rank p=0.001) in DM patients, whereas discharge SBP cut-off level was 140mmHg to discriminate 1-year MACCE in non-DM patients (6.4% versus 8.5%, log-rank p=0.045). In DM patients, there were no significant difference in 1-year MACCEs between patients with HbA1c less than 7% versus 7% or greater (12.0% versus 10.7%; log-rank p=0.325). DM patients were categorized into 4 groups; discharge SBP <130mmHg and HbA1c <7% (Group 1); discharge SBP <130mmHg and HbA1c ≥7% (Group 2); discharge SBP ≥130mmHg and HbA1c <7% (Group 3); discharge SBP ≥130mmHg and HbA1c ≥7% (Group 4). Intensive BP control was associated lower 1-year MACCEs in patients with good glycemic control (Group 1 & 3; 10.7% versus 16.7%; log-rank p=0.009). However, in patients with poor glycemic control, intensive BP control did not improve 1-year MACCEs (Group 2 & 4; 10.6% versus 11.1%; log-rank p=0.761).

Conclusion

Strict BP control is more important than glycemic control to improve short-term clinical outcome in DM patients with AMI. However, in patients with poor glycemic control, strict BP control did not improve clinical outcome.

P3583Optimal procedural strategy to improve clinical outcome in primary percutaneous coronary intervention

Background

Current guideline recommends potent antiplatelet agents and transradial intervention. However, it is uncertain whether routine use of IVUS, thrombus aspiration and glycoprotein IIB-IIIA inhibitor is beneficial for improving clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI).

Purpose

The aim of this study was to investigate optimal procedural strategy to improve clinical outcome.

Methods

A total of 6,046 patients who underwent primary percutaneous coronary intervention (PCI) for STEMI were analyzed from the Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database. MACCEs were defined as a composition of all cause death, non-fatal MI, repeat revascularizations including repeated percutaneous coronary intervention and coronary bypass grafting, cerebrovascular accident and rehospitalizations. This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.

Results

During the primary PCI, potent antiplatelet agents such as prasugrel and ticagrelor were used in 2342 (38.4%). PCI was performed through transradial approach in 1490 (25.2%). Thrombus aspiration and intravascular ultrasound (IVUS) examination was done in 2204 (36.1%) and 1079 (18.1%), respectively. Glycoprotein IIB-IIIA inhibitor was administered in 1295 (21.7%). Among them, potent antiplatelet agents, transradial intervention, IVUS, and thrombus aspiration significantly reduced MACCEs at 1 year. Glycoprotein IIB-IIIA inhibitor was not effective to improved clinical outcome. In Cox-proportional hazards model, potent antiplatelet agents (hazard ratio 0.82, 95% confidence interval 0.67–0.99; p=0.045) and transradial intervention (hazard ratio 0.61, 95% confidence interval 0.47–0.78; p<0.001) was an independent predictor of MACCEs after adjusting for confounding variables. Combined use of potent antiplatelet agents and transradial intervention (hazard ratio 0.54; 95% confidence interval 0.37–0.80; p=0.002) substantially reduced MACCEs at 1 year.

Conclusion

Among evidence based procedures during the primary PCI, combined use of potent antiplatelet agents and transradial intervention was optimal procedural strategy to improve clinical outcome.

The effects of cardiac arrest recognition by dispatcher on Smart Advanced Life Support

Objectives:

The purpose of this study was to analyze the effect of cardiac arrest recognition by emergency medical dispatch on the pre-hospital advanced cardiac life support and to investigate the outcome of out-of-hospital cardiac arrest.

Method:

This study was conducted to evaluate the out-of-hospital cardiac arrest patients over 18 years of age, excluding trauma and poisoning patients, from 1 August 2015 to 31 July 2016. We investigated whether it was a cardiac-arrest recognition at dispatch. We compared the pre-hospital return of spontaneous circulation, the rate of survival admission and discharge, good neurological outcome, and also analyzed the time of securing vein, time of first epinephrine administration, and arrival time of paramedics.

Results:

A total of 3695 out-of-hospital cardiac arrest patients occurred during the study period, and 1468 patients were included in the study. Resuscitation rate by caller was significantly higher in the recognition group. The arrival interval between the first and second emergency service unit was shorter as 5.1 min on average, and the connection rate of paramedics and physicians before the arrival was 32.3%, which was significantly higher than that of the unrecognized group. The mean time required to first epinephrine administration was 13.1 min, which was significantly faster in the recognition group. However, there was no statistically significant difference between the two groups in patients with good neurological outcome, and rather the rate of return of spontaneous circulation and survival discharge was significantly higher in the non-recognition group.

Conclusion:

Although the recognition of cardiac arrest at dispatch does not directly affect survival rate and good neurological outcome, the activation of pre-hospital advanced cardiac life support and the shortening the time of epinephrine administration can increase pre-hospital return of spontaneous circulation. Therefore, effort to increase recognition by dispatcher is needed.

Effect of Postoperative Xylitol Nasal Irrigation on Patients with Sinonasal Diseases

OBJECTIVE

To examine the effect of xylitol nasal irrigation in a large sample size of patients who had undergone nasal surgery.

STUDY DESIGN

Double-blinded randomized controlled crossover study.

SETTING

Tertiary referral center.

METHODS

The study included 100 patients with sinonasal disease who underwent endoscopic sinus surgery (ESS), septoplasty, or both concurrently. To identify patients with allergic sensitization, serum-specific immunoglobulin E levels were measured. Nasal symptoms were evaluated with the NOSE (Nasal Obstruction Symptoms Evaluation) and SNOT-20 (Sino-Nasal Outcome Test-20) and via visual analog scale (VAS) scores.

RESULTS

In the ESS group (n = 34), the general nasal symptom score evaluated by the SNOT-20 showed significantly greater improvement in the xylitol group versus the saline group ( P = .022). VAS symptom scores for sneezing ( P = .003), headache ( P = .02), and facial pain ( P = .037) were also more improved in the xylitol group. In the septoplasty group (n = 39), the VAS score for nasal stuffiness showed a significantly greater improvement in the xylitol group when compared with the saline irrigation group ( P = .001). Among the patients with allergic sensitization (n = 31), rhinorrhea symptoms improved significantly more in the xylitol group than in the saline group ( P = .024). The preference survey showed that more than half of the patients in each surgical group preferred xylitol irrigation.

CONCLUSION

We found that xylitol nasal irrigation was useful in postoperative ESS and septoplasty care. For patients with allergic sensitization, rhinorrhea showed greater improvement in the xylitol group than in the saline group.

Anion gap and base deficit are predictors of mortality in acute pesticide poisoning

BACKGROUND:

Acute pesticide poisoning has long been a serious problem as a method of suicide worldwide. This poisoning is a highly fatal condition that requires a rapid and precise diagnosis for adequate treatment. However, various studies on mortality predictor factors have been insufficient for whole pesticide treatments. We hypothesized that the initial plasma anion gap (AG) and base deficit (BD) are reliable prognostic factors.

METHODS:

A retrospective study analyzed 561 patients with a diagnosis of acute pesticide poisoning between January 1, 2014 and June 30, 2017. The initial AG and BD values were divided into quartiles according to the number of patients. Survival at 30 days from admission was estimated using the Kaplan-Meier survival analysis. Receiver-operator characteristic (ROC) curves were drawn, and the areas under the curve for AG and BD for mortality were calculated.

RESULTS:

Fifty-eight (10.3%) of 561 patients died within 30 days. The highest AG quartile (>22 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with an AG less than 14.7 mEq/L, these patients had a 4.18-fold higher risk of 30-day hospital mortality and the highest BD quartile (>7.9 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with a BD less than 1.4 mEq/L, these patients had 2.23-fold higher risk of 30-day hospital mortality. The areas under the ROC for AG and BD curve were 0.699 and 0.744, respectively.

CONCLUSIONS:

Initial high AG and BD values could predict mortality and require precise intensive care.

Is Septoplasty Necessary When Using the Endoscopic Endonasal Transsphenoidal Approach for a Deviated Nasal Septum?

Objective  This article describes the role played by endoscopic endonasal transsphenoidal approach (EETSA) to the sphenoidal process of the septal cartilage of a deviated nasal septum. Design  Case series with chart review. Setting  Tertiary referral center. Participants  Between 2009 and 2016, 177 patients with skull base tumors who underwent EETSA were included. Main Outcome Measures  In 8 cases, the conventional two nostrils-four hands technique was employed (group A). In 16 cases, we placed a right-side conventional nasoseptal flap and a left-side modified nasoseptal rescue flap (group B), and in 153 cases, bilateral modified nasoseptal rescue flaps (group C). The number of septoplasty-required cases and the change of nasal cavity area differences reflecting septal deviation were measured. Results  Septoplasty during EETSA was performed in two cases: one from group B and one from group C. There was no significant difference in the ratio of septoplasty-required cases among the three groups ( p  = 0.127). Between pre- and postoperative nasal cavity, the cross-sectional area difference at the anterior end of the middle turbinate level significantly decreased ( p  = 0.045). Also, the angle of deviation at the level of ostiomeatal unit significantly decreased after EETSA ( p  < 0.001). Conclusion  Separation of a deviated complex surrounding the sphenoidal process of the septal cartilage is the key to relieving a deviated nasal septum. EETSA combined with the two nostrils-four hands technique allows posterior septectomy (including removal of this deviated complex) to be performed. Thus, EETSA may commence without preceding septoplasty even in cases with severe nasal septum deviations.

Endoscopic Transseptal Approach with Bilateral Nasoseptal Flap in Challenging Skull-Base Tumors

OBJECTIVE

We sought to examine the utility of an endoscopic transseptal approach and creation of a bilateral nasoseptal flap using a 2-nostrils/4-hands technique in patients with challenging skull-base tumors.

METHODS

The medical records of patients operated on via an endoscopic transseptal approach between 2009 and 2017 were retrospectively reviewed. Two patients with ossifying fibroma, 2 with orbital hemangioma, 2 with trigeminal nerve schwannoma, and 1 patient each with juvenile angiofibroma, meningioma, and myxofibrosarcoma were included in the study. The surgical technique and endoscopic anatomy are presented.

RESULTS

The mean age of the 4 male and 5 female patients was 39.9 ± 14.8 years. By using this technique, all 7 tumors were resected with minimal nasal morbidity after a mean follow-up of 15.2 ± 9.4 months.

CONCLUSIONS

The endoscopic transseptal approach, by creation of a bilateral nasoseptal flap using a 2-nostrils/4-hands technique, improves surgical visualization and increases instrument maneuverability. Surgical access to challenging skull-base tumors is therefore afforded. The procedure also reduces nasal morbidity by preserving the lacrimal apparatus and anterior maxilla structures and avoiding septal perforation and traumatic nose traction.

Effects of changes in nasal volume on voice in patients after endoscopic endonasal transsphenoidal surgery

OBJECTIVE

To investigate a potential correlation between changes in voice and changes in nasal volume.

METHODS

The endoscopic endonasal transsphenoidal approach (EETSA) was performed on 120 patients between February 2009 and August 2016 by using the bilateral modified nasoseptal rescue flaps method. All the patients were subjected to pre- and postoperative paranasal computed tomography (CT) and voice evaluations by using acoustic analyses, a nasometer to measure the nasalance, and determination of the voice handicap index (VHI). Paranasal CT and the medical image processing software were used to calculate changes in nasal cavity volume in three nasal sections.

RESULTS

Enlargement of the nasal cavity after surgery was evident in all three areas (anteronasal, p < 0.001; midnasal, p = 0.005; postnasal, p = 0.025). In addition, EETSA resulted in significantly higher mean nasalance scores for the oronasal passage (p < 0.001) and nasal passage (p < 0.001); more frequency perturbation (jitter) (p < 0.001) and amplitude perturbation (shimmer) (p < 0.001); and higher grade, roughness, breathiness, asthenia, and strain scores (p < 0.001), and VHI (p = 0.01). However, only changes in the nasal volume after EETSA correlated with postnasal hypernasality (r = 0.2; p = 0.029).

CONCLUSION

Although changes in nasal volume, voice, and speech may develop after EETSA, we found that changes in nasal volume were not correlated with changes in any voice-quality measure. However, the postnasal cavity was the region most dramatically affected by EETSA, and postnasal volume changes after surgery may be associated with hypernasal speech.

Combined Administration of IV and Topical Tranexamic Acid is Not Superior to Either Individually in Primary Navigated TKA

BACKGROUND

In this study, we tried to assess if combined method (intravenous [IV] and topical) of tranexamic acid (TXA) administration, which has been shown to be superior in conventional arthroplasty, has similar effect in navigational arthroplasty compared to administration of drug either individually.

METHODS

In present randomized control trial, 200 patients were randomly divided in one of the 4 groups using computer-generated tables-control, IV, intraarticular, and combined. We studied evident loss through drain, total loss based on Gross method and hemoglobin balance method, hidden losses, hemoglobin and hematocrit drop, functional scores, and all possible complications related to TXA.

RESULTS

Evident loss in combined group was 535.55 mL, not significantly less than IV (585 mL, P = .15) and intraarticular group (514 mL, P = .74). However, these were significantly less than control group (696 mL, P = .000). Functional scores and recovery rates were, however, comparable in all 4 groups. No patients in any group developed symptomatic deep vein thrombosis.

CONCLUSION

Tranexamic use decreases blood loss in navigation-assisted arthroplasty, however, less than that observed for conventional arthroplasty in literature. Further, combined group has no added advantage over other methods of drug administration. We believe that additional amount of TXA administered in combined regimen may not be clinically useful. Further TXA group did not have any advantage in terms of functional recovery over control group.

A randomized control trial to evaluate the effectiveness of intravenous, intra-articular and topical wash regimes of tranexamic acid in primary total knee arthroplasty

BACKGROUND

The efficacy of tranexamic acid to decrease post-operative blood loss and blood transfusion is well established in literature. However, the ideal mode of administration is debatable. Limited literature has compared all the available modes of administration including intravenous (IV), topical irrigation and retrograde through drain. We hypothesized that no difference would be present in either form of administration of tranexamic acid.

METHODS

Fifty patients in four groups were enrolled for study. Group 1 received drug intravenously, group 2 had topical washing with drug before closure, group 3 received drug after closure through drain and group 4 was control that received no tranexamic acid. Post-operative blood loss, calculated blood loss, haemoglobin drop, transfusion requirements and complications were studied for all four groups.

RESULTS

Tranexamic acid results in lower bleeding irrespective of the mode of administration compared to control group. Total loss at end of 5 days is similar in all tranexamic acid groups irrespective of method used to deliver the drug. Calculated blood loss and haemoglobin drop was minimum for IV and in patients who were administered drug retrograde through drain. Requirement for blood transfusion was found to be lower in all tranexamic acid patients compared to non-tranexamic acid group. The requirement was highest in topical wash group among all tranexamic acid groups.

CONCLUSION

We conclude that intra-articular administration through drain and IV administration are equally effective and superior to topical wash method in reducing blood loss, haemoglobin fall and transfusion requirements.

Prognosis of Olfactory Dysfunction according to Etiology and Timing of Treatment

Objective We evaluated the severity of olfactory impairment according to risk factors, compared responses with risk factors and treatment timing, and investigated prognosis according to treatments. Study design Case series with chart review. Setting Tertiary referral center. Subjects and Methods We retrospectively reviewed medical records of patients complaining of loss of their sense of smell between January 2006 and May 2016. In total, 491 patients were included. We evaluated olfactory function using the Connecticut Chemosensory Clinical Research Center test (threshold test) and Cross-cultural Smell Identification Test. Results Post-upper respiratory infection patients showed better results than those with other risk factors (59.6% recovered). Patients with head trauma (12.5% recovered) and congenital olfactory dysfunction (0% recovered) showed poorer results. Earlier treatment showed better olfactory recovery outcomes for post-upper respiratory infection ( P = .001), head trauma ( P = .022), and nasal/sinus surgery ( P = .009). Xerostomia ( P = .73) and idiopathy ( P = .365) showed no significant difference in terms of treatment timing. The threshold test better reflected subjective recovery than the identification test. The systemic + topical steroid group and the systemic steroid treatment group both showed better smell recovery outcomes than the group with topical treatment alone (both, P < .001). However, there was no significant difference between the systemic treatment group and the systemic + topical treatment group ( P = .978). Conclusions Our findings suggest that the duration of smell loss is important for better olfactory outcomes with most etiologies. Also, the effects of systemic steroids were better than those of topical steroids, regardless of combined treatment.

Results from the Survey of Antibiotic Resistance (SOAR) 2012-14 in Thailand, India, South Korea and Singapore

OBJECTIVES

To provide susceptibility data for community-acquired respiratory tract isolates of Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and Moraxella catarrhalis collected in 2012-14 from four Asian countries.

METHODS

MICs were determined using Etest(®) for all antibiotics except erythromycin, which was evaluated by disc diffusion. Susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. For macrolide/clindamycin interpretation, breakpoints were adjusted for incubation in CO2 where available.

RESULTS

Susceptibility of S. pneumoniae was generally lower in South Korea than in other countries. Penicillin susceptibility assessed using CLSI oral or EUCAST breakpoints ranged from 21.2% in South Korea to 63.8% in Singapore. In contrast, susceptibility using CLSI intravenous breakpoints was much higher, at 79% in South Korea and ∼95% or higher elsewhere. Macrolide susceptibility was ∼20% in South Korea and ∼50%-60% elsewhere. Among S. pyogenes isolates (India only), erythromycin susceptibility (∼20%) was lowest of the antibiotics tested. In H. influenzae antibiotic susceptibility was high except for ampicillin, where susceptibility ranged from 16.7% in South Korea to 91.1% in India. South Korea also had a high percentage (18.1%) of β-lactamase-negative ampicillin-resistant isolates. Amoxicillin/clavulanic acid susceptibility for each pathogen (PK/PD high dose) was between 93% and 100% in all countries except for H. influenzae in South Korea (62.5%).

CONCLUSIONS

Use of EUCAST versus CLSI breakpoints had profound differences for cefaclor, cefuroxime and ofloxacin, with EUCAST showing lower susceptibility. There was considerable variability in susceptibility among countries in the same region. Thus, continued surveillance is necessary to track future changes in antibiotic resistance.

Whole-breast US following mammography and breast MRI in newly diagnosed breast cancer patients: can it be more than just a guidance tool for biopsy?

AIM

To evaluate the role of ultrasound (US) following magnetic resonance imaging (MRI) and mammography in patients with newly diagnosed breast cancers by assessing the additional cancer detection rate of US.

MATERIAL AND METHODS

Two hundred and twenty-five women who had undergone 225 MRI examinations followed by US were included. An US-detected additional cancer was defined as a lesion detected using breast US that had not been detected by MRI, and which was shown to be malignant at histopathology. The rate of additional cancer detection, incidence of additional malignancies, positive predictive value (PPV), and false-positive (FP) rate were analysed. Factors associated with an increase in the additional cancer detection rate were analysed.

RESULTS

The additional cancer detection rate was 0% (0/225) for the ipsilateral breast and 0.9% (2/225) for the contralateral breast, and the PPVs were 0% (0/5) and 100% (2/2), respectively. The overall TP:FP ratio was 0.4 (2:5). The additional cancer detection rate was higher for cases with moderate and severe background parenchymal enhancement than cases with minimal and mild background parenchymal enhancement (p=0.003). The additional cancer detection rate for cases with moderate and severe background parenchymal enhancement was 5.7% (2/35) for the contralateral breast (p=0.003).

CONCLUSION

Preoperative breast US following MRI and mammography can help clinicians screen for contralateral cancers with an additional detection rate of 0.9%. Moreover, whole-breast US might be a useful contralateral screening modality in cases with moderate or marked parenchymal enhancement on breast MRI.

Invagination of the Sphenoid Sinus Mucosa after Endoscopic Endonasal Transsphenoidal Approach and Its Significance

Objective

To describe the clinical features of invagination of the sphenoid sinus mucosa (ISM) and compare them with other similar cases using a visual analog scale (VAS) to assess the various nasal symptoms and to discuss its clinical significance and means of prevention.

Study Design

Retrospective chart review at a tertiary referral center.

Methods

Between 2010 and 2015, 8 patients who had undergone EETSA surgery displayed postoperative ISM. The comparison group consisted of 147 patients who underwent the same surgical procedures and were diagnosed with the same diseases. Pre- or postoperative paranasal sinus computed tomography (PNS CT) and VAS were performed and subsequently analyzed.

Results

The clinical features of ISM of the sphenoid sinus showed sellar floor invagination and regenerated inverted ingrowing sphenoid mucosa on endoscopic imaging. PNS CT also showed a bony defect and invaginated air densities at the sellar turcica. Pre- and postoperative VAS scores revealed that the ISM group had much less of an improvement in headaches after surgery than that of the comparison group (p = 0.049).

Conclusion

ISM may occur because of a change in pressure, sphenoid mucosal status, or arachnoid membrane status. Moreover, ISM is related to improvements in headaches. Therefore, EETSA patients should avoid activities that cause rapid pressure changes during the healing process. In addition, sellar reconstruction that is resistant to physical pressure changes should be mandated despite the absence of an intraoperative CSF leak.

Intranasal Volume Changes Caused by the Endoscopic Endonasal Transsphenoidal Approach and Their Effects on Nasal Functions

OBJECTIVE

We evaluated postoperative changes in nasal cavity volume and their effects on nasal function and symptoms after endoscopic endonasal transsphenoidal approach for antero-central skull base surgery.

STUDY DESIGN

Retrospective chart review at a tertiary referral center.

METHODS

We studied 92 patients who underwent binostril, four-hand, endoscopic endonasal transsphenoidal approach surgery using the bilateral modified nasoseptal rescue flap technique. Pre- and postoperative paranasal computed tomography and the Mimics® program were used to assess nasal cavity volume changes at three sections. We also performed several pre- and postoperative tests, including the Connecticut Chemosensory Clinical Research Center test, Cross-Cultural Smell Identification Test, Nasal Obstruction Symptoms Evaluation, and Sino-Nasal Outcome Test-20. In addition, a visual analog scale was used to record subjective symptoms. We compared these data with the pre- and postoperative nasal cavity volumes.

RESULTS

Three-dimensional, objective increases in nasal passage volumes were evident between the inferior and middle turbinates (p<0.001) and between the superior turbinate and choana (p = 0.006) postoperatively. However, these did not correlate with subjectively assessed symptoms (NOSE, SNOT-20 and VAS; all nasal cavity areas; p≥0.05) or olfactory dysfunction (CCCRC and CCSIT test; all nasal cavity areas; p≥0.05).

CONCLUSION

Skull base tumor surgery via an endoscopic endonasal transsphenoidal approach altered the patients' nasal anatomy, but the changes in nasal cavity volumes did not affect nasal function or symptoms. These results will help surgeons to appropriately expose the surgical field during an endoscopic endonasal transsphenoidal approach.

Anatomic Changes Caused by Endoscopic Endonasal Transsphenoidal Surgery and Their Effects on Nasal Functions

OBJECTIVE

We evaluated postoperative changes in nasal cavity dimensions and their effects on nasal functions and symptoms.

STUDY DESIGN

Case series with chart review.

SETTING

Tertiary referral center.

SUBJECTS AND METHODS

We studied patients who underwent binostril, 4-hand endoscopic endonasal transsphenoidal approach surgery with the bilateral modified nasoseptal rescue flap technique. Pre- and postoperative paranasal computed tomography scans were used to assess nasal cavity dimensional changes at 4 levels. We also performed several pre- and postoperative tests, including the Connecticut Chemosensory Clinical Research Center test and the Cross-Cultural Smell Identification Test (n = 119) to evaluate olfactory functions. Also, the Nasal Obstruction Symptoms Evaluation, the Sino-Nasal Outcome Test-20, and a visual analog scale were used (n = 157) to record subjective symptoms. We compared these data with the pre- and postoperative nasal cavity dimensions.

RESULTS

Two-dimensional objective increases in nasal passage dimensions were evident postoperatively (all cross-sectional areas, P < .001, except choana and left inferior turbinate). However, these did not correlate with subjectively assessed symptoms (Nasal Obstruction Symptoms Evaluation, all cross-sectional areas, P ≥ .05, except right middle turbinate; Sino-Nasal Outcome Test-20, all cross-sectional areas, P ≥ .05) or olfactory dysfunction evaluated with the Connecticut Chemosensory Clinical Research Center test (all cross-sectional areas, P ≥ .05) or the Cross-Cultural Smell Identification Test (all cross-sectional areas, P ≥ .05).

CONCLUSION

Endoscopic endonasal transsphenoidal approach surgery altered the patients' nasal anatomy, but the changes in nasal cavity dimensions did not affect nasal functions and symptoms. These results will help surgeons to appropriately expose the surgical field during endoscopic endonasal transsphenoidal approach surgery.

High-normal free thyroxine levels are associated with low trabecular bone scores in euthyroid postmenopausal women

Trabecular bone scores (TBS) have recently been developed as a diagnostic tool to assess bone texture. We studied thyroid status and TBS in a population-based cohort and demonstrated that high-normal thyroxine levels are associated with low TBS in healthy euthyroid postmenopausal women.

INTRODUCTION

Increased thyroid hormone levels affect bone mineral density (BMD) and, if untreated, increase the risk of fracture. However, the relationship between thyroid function and bone microarchitecture has not yet been established. Trabecular bone scores (TBS) are gray-level textural measurements of dual energy X-ray absorptiometry (DXA) images. The TBS has been proposed as an indirect index of bone microarchitecture. The goal of this study was to characterize the relationship between thyroid function and TBS in euthyroid men and postmenopausal euthyroid women.

METHODS

A total of 1376 euthyroid subjects (648 postmenopausal women and 728 men) were recruited from a community-based cohort in Korea. Free thyroxine (fT4) levels, thyroid stimulating hormone (TSH) levels, BMD, and TBS were measured and compared.

RESULTS

There was no significant relationship between either fT4 or TSH levels and BMD in men and women. Multiple linear regression analysis showed that high-normal fT4 levels were negatively correlated with TBS (β = -0.111; P = 0.002, after adjusting for both age and body mass index [BMI]) in postmenopausal women. In men, however, there was no significant correlation between fT4 levels and TBS. TSH levels were not significantly associated with TBS in either men or women.

CONCLUSION

Higher fT4 levels within the normal reference range are associated with deterioration of trabecular microarchitecture in healthy euthyroid postmenopausal women.