OBJECTIVES: Doxycycline is commonly used in medicine for its bacteriostatic antimicrobial properties. Recent studies have reported that doxycycline also has anti-inflammatory effects. Matrix metalloproteinase (MMP)-9 has been found to be involved in the physiological and pathological process of inflammatory airway disease. Phorbol 12-myristate 13-acetate (PMA), a protein kinase C activator, is known to stimulate the expression of MMP and mucin genes in the airway and intestinal epithelial cells. Therefore, the effects and signal pathways of doxycycline on PMA-induced MUC5B expression dependent MMP-9 in human airway epithelial cells were investigated. METHODS: In human NCI-H292 airway epithelial cells, MUC5B and MMP-9 mRNA expression, MUC5B protein expression, and MMP-9 protein activity after the treatment with PMA, MMP-9 or doxycycline were determined by reverse transcriptase-polymerase chain reaction, enzyme immunoassay, gelatin zymography, and Western blot analysis. RESULTS: PMA increased MMP-9 and MUC5B expression. MMP-9 increased MUC5B expression. Doxycycline inhibited PMA-induced MUC5B expression, and PMA-induced MMP-9 mRNA expression and protein activity. Doxycycline inhibited phosphorylation of p38 induced by PMA and MMP-9. CONCLUSION: The results of this study suggest that doxycycline inhibited PMA-induced MUC5B mRNA expression and protein production through the MMP-9 and p38 pathways in human NCI-H292 airway epithelial cells.
Blotting, Western ; Doxycycline ; Epithelial Cells ; Gelatin ; Humans ; Immunoenzyme Techniques ; Inflammation ; Matrix Metalloproteinase 9 ; Mucins ; Phorbols ; Phosphorylation ; Protein Kinase C ; RNA, Messenger ; Signal Transduction ; Tetradecanoylphorbol Acetate ; Thiram

BACKGROUND: Computed tomography (CT) is commonly used to evaluate the degree of sinus involvement in cases of inverted papilloma (IP). However, CT cannot differentiate tumor from adjacent inflammatory mucosa or retained secretions. By contrast, magnetic resonance imaging (MRI) has been reported to be useful in distinguishing IP from paranasal sinusitis. This study investigated whether preoperative assessment with MRI and CT accurately predict the extent of IP. MATERIALS AND METHODS: CT and MRI were retrospectively reviewed in 9 cases of IP. Patients were categorized into stages based on CT and MRI findings, according to the staging system proposed by Krouse. The involvement of IP in each sinus was also assessed. RESULTS: Differentiation of IP from inflammatory disease may be more successful in routine cases where the inflammatory mucosa has low signal intensity on T1-weighted images and very high signal intensity on T2-weighted images. CT imaging could not differentiate tumor from adjacent inflammatory mucosa or retained secretions. CONCLUSION: Preoperative MRI of IP can predict the location and extent of the tumor involvement in the paranasal sinuses and sometimes predicts malignant changes.
Humans ; Magnetic Resonance Imaging* ; Mucous Membrane ; Papilloma, Inverted* ; Paranasal Sinuses ; Retrospective Studies ; Sinusitis

BACKGROUND AND OBJECTIVES : Facial palsy of herpes zoster oticus has rapid onset, is usually severe in degree, and poorer in prognosis than Bell's palsy. In the past, herpes zoster oticus has usually been treated with acyclovir and steroid, but recently, applying stellate ganglion block for herpes zoster oticus has been recognized as an additional treatment that may improve facial palsy. This study was designed to evaluate the effect of stellate ganglion block on herpes zoster oticus. Subjects and METHOD : We reviewed retrospectively the medical records of 30 patients with herpes zoster oticus who were treated with acyclovir, steroid and stellate ganglion block between January 1995 and December 2004. The follow-up period was at least over than 6 months. RESULTS : All patients suffered from otalgia, vesicle, and facial palsy. The average degree of House-Brackmann classification on admission was 3.26 in the complete recovery patients and 4.61 in the incomplete recovery patients. Seventeen patients were completely recovered from facial palsy (56.7%), and 13 showed residual facial palsy 13 patients(43.3%). The poor prognosis may be related with early onset of facial palsy, high degree of House-Brackmann classification on admission and high degenerative ratio on electroneurography of facial nerve. CONCLUSION : The additional treatment of stellate ganglion block in herpes zoster oticus may not be effective on improving the complete recovery rate and prognosis.
Acyclovir ; Bell Palsy ; Classification ; Earache ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Herpes Zoster Oticus* ; Herpes Zoster* ; Humans ; Medical Records ; Paralysis ; Prognosis ; Retrospective Studies ; Stellate Ganglion*

BACKGROUND AND OBJECTIVES: Recent advances in medical management, along with increased life span, have contributed to the increased opportunity for detecting multiple primary malignancy (MPM). The purpose of this study was to evaluate the incidence and clinical characteristics of MPM in the head and neck region. SUBJECTS AND METHOD: We reviewed retrospectively the medical records of 984 patients with malignant tumors of head and neck who had been diagnosed histopathologically and treated between August 1985 to July 2005. RESULTS: Seventy patients (7.11%) were diagnosed as having MPM (double, n=66 ; triple, n=4). This group consisted of 67 men and 3 women (p<0.01). Twenty-five patients (36%) had synchronous double primary malignancy (SDPM) and 45 patients (64%) had metachronous double primary malignancy (MDPM). The hypopharynx was the most frequently involved site of the index tumor. The most common index tumors were squamous cell carcinoma histopathologically. Second primary malignancies were found in esophagus, stomach and lung. Fifty-five patients were found with first primary malignancy in head and neck, and 25 were with second primary malignancy. The patients with first and second primary malignancy in head and neck were 10 cases. The prognosis of SDPM (average of survival 11.1 months) was very poor. Patients with MPM have high cigarettes smoking and alcohol drinking habit. CONCLUSION: Patients with head and neck malignancies will require careful follow up for prevention, early detection, and the treatment of second primary malignancy.
Alcohol Drinking ; Carcinoma, Squamous Cell ; Esophagus ; Female ; Head and Neck Neoplasms ; Head* ; Humans ; Hypopharynx ; Incidence ; Lung ; Male ; Medical Records ; Neck* ; Neoplasms, Multiple Primary ; Prognosis ; Retrospective Studies ; Smoke ; Smoking ; Stomach ; Tobacco Products

BACKGROUND AND OBJECTIVES: Cyclin D1 is one of the proteins regulating G1-S transition in the cell cycle and is considered to play an important role in subsequent mitotic division. So it is a candidate of a proto-oncogene implicated in the pathogenesis of several human tumor types, including laryngeal squamous cell carcinomas. The purpose of this study was to investigate the development of tumorigenesis and clinicopathologic means of cyclin D1 protein in squamous cell carcinoma of the larynx. SUBJECTS AND METHOD: Sixty two patients, who have been treated with benign lesion (keratosis and chronic inflammation), dysplasia or squamous cell carcinoma of the larynx from March 1994 to December 1996 were investigated for this purpose. cyclin D1 protein was detected by immunohistochemical technique in the paraffin embedded tissues. RESULTS: The expression of cyclin D1 protein was detected in 6 out of 11 cases (54.5%) in benign lesion, 3 out of 5 cases (60.0%) in mild to moderate dysplasia, 12 out of 18 cases (66.7%) in severe dysplasia and carcinoma in situ, and 36 out of 44 cases (81.8%) in invasive squamous cell carcinoma of the larynx. Of these, the expression of cyclin D1 protein in invasive squamous cell carcinoma was the highest positive rate, and there was significant difference (p<0.05). However, the expression of cyclin D1 protein was not correlated with degree of differentiation, anatomical site, T-stage and N-stage in invasive squamous cell carcinoma of the larynx (p>0.05). CONCLUSION: Cyclin D1 protein may be considered to play an important role in the development of the tumorigenesis in invasive squamous cell carcinoma of the larynx.
Carcinogenesis ; Carcinoma in Situ ; Carcinoma, Squamous Cell ; Cell Cycle ; Cyclin D1* ; Cyclins* ; Humans ; Inflammation* ; Laryngeal Mucosa* ; Larynx ; Paraffin ; Proto-Oncogenes

BACKGROUND: Obesity induced by high-fat diet (HFD) is one of the most widespread metabolic disorders in current society. However, there has been little research regarding the effects of HFD-induced obesity in the septa of animal models of cerebral ischemia. Therefore, in the present study, we investigated septal effects of HFD on neuronal damage and gliosis induced by transient cerebral ischemia. METHODS: Body weight, blood glucose levels and serum lipid profiles levels were measured both in the normal diet (ND) and HFD-group. We also investigated the effects of ND and HFD on neuronal damage and gliosis in the septum after transient cerebral ischemia using immunohistochemistry. RESULTS: The levels of blood glucose, serum triglyceride, and total cholesterol were significantly increased in the HFD-fed gerbils compared with the ND-fed gerbils, although body weight was not significantly changed after HFD feeding. In the ND-fed gerbils, ischemia-induced neuronal damage was found in the septohippocampal nucleus (SHN) of the septum 7 days after ischemia. In the HFD-fed gerbils, ischemia-induced neuronal damage in the SHN was much more severe compared with that of the ND-fed gerbils 4 and 7 days after ischemia. In addition, we found that ischemia-induced glial activation including astrocytes and microglia was accelerated and exacerbated in the HFD-fed gerbils compared with that in the ND-fed gerbils. CONCLUSION: These results indicate that HFD can lead to much more severe effects in ischemia-induced neuronal damage/death in the septum after ischemia-reperfusion, and that it may be associated with accelerated change in glial activation.
Astrocytes ; Blood Glucose ; Body Weight ; Brain Ischemia ; Cholesterol ; Diet ; Diet, High-Fat ; Dietary Fats* ; Gerbillinae* ; Gliosis ; Immunohistochemistry ; Ischemia ; Ischemic Attack, Transient* ; Microglia ; Models, Animal ; Neurons* ; Obesity ; Triglycerides

Chronic constipation (CC) may impact on quality of life. There is substantial patient dissatisfaction; possible reasons are failure to recognize underlying constipation, inappropriate dietary advice and inadequate treatment. The aim of these practical guidelines intended for primary care physicians, and which are based on Asian perspectives, is to provide an approach to CC that is relevant to the existing health-care infrastructure. Physicians should not rely on infrequent bowel movements to diagnose CC as many patients have one or more bowel movement a day. More commonly, patients present with hard stool, straining, incomplete feeling, bloating and other dyspeptic symptoms. Physicians should consider CC in these situations and when patients are found to use laxative containing supplements. In the absence of alarm features physicians may start with a 2-4 week therapeutic trial of available pharmacological agents including osmotic, stimulant and enterokinetic agents. Where safe to do so, physicians should consider regular (as opposed to on demand dosing), combination treatment and continuous treatment for at least 4 weeks. If patients do not achieve satisfactory response, they should be referred to tertiary centers for physiological evaluation of colonic transit and pelvic floor function. Surgical referral is a last resort, which should be considered only after a thorough physiological and psychological evaluation.
Asia ; Asian Continental Ancestry Group ; Colon ; Constipation ; Health Resorts ; Humans ; Pelvic Floor ; Physicians, Primary Care ; Primary Health Care ; Quality of Life ; Referral and Consultation ; Sprains and Strains

PURPOSE: High sensitive C-reactive protein (hs CRP) is well known as a strong risk factor of cardiovascular disease (CVD). The aim of this study is to evaluate the impact of elevated hs CRP on coronary artery spasm (CAS) as assessed by intracoronary acetylcholine (ACh) provocation test. MATERIALS AND METHODS: A total of 1729 consecutive patients without significant CVD who underwent coronary angiography and intracoronary ACh test between November 2004 and August 2010 were analyzed. The patients were divided into five groups according to quintiles of hs CRP levels. RESULTS: At baseline, the prevalence of elderly, hypertension, diabetes mellitus, current smoking, and lipid levels were higher in patients with higher hs CRP. During ACh test, the incidences of significant CAS, ischemic electrocardiography (EKG) change, multivessel, and diffuse CAS were higher in patients with higher hs CRP. Multivariate analysis showed that the old age (OR=1.01, CI; 1.0-1.02, p=0.0226), myocardial bridge (OR=3.34, CI; 2.16-5.17, p<0.001), and highest quintile hs CRP (OR=1.54, CI; 1.12-2.18, p=0.008) were independent predictors of ACh induced CAS. However, there was no difference in clinical outcomes up to 12 months. CONCLUSION: In conclusion, higher hs CRP was associated with higher incidence of CAS, worse angiographic characteristics and ischemic EKG change, but was not associated with clinical outcomes.
Acetylcholine/*metabolism ; Adult ; C-Reactive Protein/*metabolism ; Coronary Vasospasm/*metabolism ; Diabetes Mellitus/metabolism ; Female ; Humans ; Hypertension/metabolism ; Male ; Middle Aged ; Retrospective Studies

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.