BACKGROUND: Parotidectomy is the treatment of choice in many parotid tumors. Due to the extensive nature of the procedure, unfavorable complications such as gustatory sweating, surgical site depression are common. Various techniques using fascia, muscle or AlloDerm have been developed but debate still remains regarding its availability and affordability. We applied a newly developed acellular dermal matrix (Insuregraf) to the parotidectomy field to act as a physical barrier and to provide adequate filling effect for prevention of functional and aesthetic complications. METHODS: From March 2010 to March 2017, 30 patients with parotid tumors underwent superficial parotidectomy. Twenty patients underwent only superficial parotidectomy. Ten patients had Insuregraf applied to the surgical site after superficial parotidectomy. We evaluated the incidence of Frey’s syndrome, surgical site depression, and patient satisfaction rate in both groups. RESULTS: The incidence of Frey’s syndrome was lower in the Insuregraf group (0 vs. 2). Surgical site depression was also lower in the Insuregraf group (2 vs. 20). Satisfaction score for facial contour in Insuregraf group was 9.2 out of 10, which was comparable to 6.2 out of 10 in the control group. CONCLUSION: Application of Insuregraf after superficial parotidectomy is an effective surgical procedure to prevent complications such as Frey’s syndrome and surgical site depression. This technique is affordable and safe with no immune reactions. Above all this surgical method should be considered as an option for patients who are concerned about the contour of the face after surgery.
Acellular Dermis ; Architectural Accessibility ; Collagen ; Depression ; Facial Asymmetry ; Fascia ; Humans ; Incidence ; Methods ; Parotid Neoplasms ; Patient Satisfaction ; Sweating, Gustatory

PURPOSE: Clinical use of cardiopulmonary exercise tests (CPETs) is increasing in elderly patients with cardiovascular (CV) diseases. However, data on Korean populations are limited. In this study, we aimed to examine the characteristics and safety of CPET in an elderly Korean population with CV disease. MATERIALS AND METHODS: We retrospectively analyzed records of 1485 patients (older than 65 years in age, with various underlying CV diseases) who underwent CPET. All CPET was performed using the modified Bruce ramp protocol. RESULTS: The mean age of patients was 71.6±4.7 years with 63.9% being men, 567 patients aged 60–65 years, 818 patients aged 70–79 years, and 100 patients aged 80–89 years. The mean respiratory exchange ratio was 1.09±0.14. During CPET, three adverse cardiovascular events occurred (total 0.20%), all ventricular tachycardia. All subjects showed an average exercise capacity of 21.3±5.5 mL/kg/min at peak VO2 and 6.1±1.6 metabolic equivalents of task, and men showed better exercise capacity than women on most CEPT parameters. A significant difference was seen in peak oxygen uptake according to age group (65–69 years, 22.9±5.8; 70–79 years, 20.7±5.1; 80–89 years, 17.0±4.5 mL/kg/min, p<0.001). The most common causes for CPET termination were dyspnea (64.8%) and leg pain (24.3%), with higher incidence of leg pain in octogenarians compared to other age groups (65–69 years, 22.4%; 70–79 years, 24.6%; 80–89 years, 32.0%, p<0.001). CONCLUSION: CPET was relatively a safe and useful modality to assess exercise capacity, even in an elderly Korean population with underlying CV diseases.
Aged ; Aged, 80 and over ; Architectural Accessibility ; Cardiovascular Diseases ; Dyspnea ; Exercise Test ; Female ; Humans ; Incidence ; Korea ; Leg ; Male ; Metabolic Equivalent ; Oxygen ; Retrospective Studies ; Tachycardia, Ventricular

OBJECTIVES: This study was conducted to identify and characterize the barriers and motivations to physical activity (PA) for elderly adults in Iran and other countries.METHODS: We searched 6 databases (PubMed, Embase, Scopus, Web of Science, Magiran, and the Scientific Information Database) from 2000 to the November 2017, using “aged 60 and over,” “physical activity” or “exercise,” and “motivator” and “barrier” as keywords. Two reviewers independently performed the search, screening, and quality assessment of the studies.RESULTS: In total, 34 papers were finally included in the study. The most important barriers, based on the frequency of factors, included physical problems, having no companions, and physical barriers to walking. The motivators included improving one's physical condition, being social, and suitability of the physical environment.CONCLUSIONS: Important motivators and barriers to PA were more closely related to intrapersonal factors than to the interpersonal and environmental domains. The barriers and motivators to PA in the elderly were not markedly different between Iran and other countries. Therefore, a general strategy could be designed to improve PA in the elderly.
Adult ; Aged ; Aging ; Architectural Accessibility ; Friends ; Humans ; Iran ; Mass Screening ; Motivation ; Motor Activity ; Walking

Emerging evidence demonstrates that the microbiota plays an essential role in shaping the development and function of host immune responses. A variety of environmental stimuli, including foods and commensals, are recognized by the host through the epithelium, acting as a physical barrier. Two allergic diseases, atopic dermatitis and food allergy, are closely linked to the microbiota, because inflammatory responses occur on the epidermal border. The microbiota generates metabolites such as short-chain fatty acids and poly-γ-glutamic acid (γPGA), which can modulate host immune responses. Here, we review how microbial metabolites can regulate allergic immune responses. Furthermore, we focus on the effect of γPGA on allergic T helper (Th) 2 responses and its therapeutic application.
Architectural Accessibility ; Dermatitis, Atopic ; Epithelium ; Fatty Acids, Volatile ; Food Hypersensitivity ; Microbiota ; Natural Killer T-Cells

The rapid increase in diabetes prevalence globally has contributed to large increases in health care expenditure on diabetic complications, posing a major health burden to countries worldwide. Asians are commonly observed to have poorer β-cell function and greater insulin resistance compared to the Caucasian population, which is attributed by their lower lean body mass and central obesity. This “double phenotype” as well as the rising prevalence of young onset diabetes in Asia has placed Asians with diabetes at high risk of cardiovascular and renal complications, with cancer emerging as an important cause of morbidity and mortality. The experience from Hong Kong had demonstrated that a multifaceted approach, involving team-based integrated care, information technological advances, and patient empowerment programs were able to reduce the incidence of diabetic complications, hospitalizations, and mortality. System change and public policies to enhance implementation of such programs may provide solutions to combat the burgeoning health problem of diabetes at a societal level.
Architectural Accessibility* ; Asia ; Asian Continental Ancestry Group ; Delivery of Health Care ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Health Expenditures ; Hong Kong* ; Hospitalization ; Humans ; Incidence ; Insulin Resistance ; Mortality ; Obesity, Abdominal ; Patient Participation ; Prevalence ; Public Policy

Over the past three decades, human pancreatic islet isolation and transplantation techniques have developed as a routine clinical procedure for selected patients with type 1 diabetes mellitus. However, due to the donor shortage and required chronic systemic immunosuppression, the widespread application of islet transplantation is limited. To overcome these limitations, providing a physical barrier to transplanted islet cells with encapsulating biomaterial has emerged as a promising approach to enhance engraftment and promote islet survival post-transplantation. Alginate has been considered to be a reliable biomaterial, as it enhances islet survival and does not hamper hormone secretion. Alginate-catechol (Al-CA) hydrogel was reported to provide high mechanical strength and chemical stability without deformation over a wide range of pH values. In this study, we, demonstrated, for the first time in the literature, that encapsulation of murine pancreatic islet cells with Al-CA hydrogel does not induce cytotoxicity ex vivo for an extended period; however, it does markedly abate glucose-stimulated insulin secretion. Catechol should not be considered as a constituent for alginate gelation for encapsulating islet cells in the application of islet transplantation.
Architectural Accessibility ; Diabetes Mellitus, Type 1 ; Humans ; Hydrogel ; Hydrogen-Ion Concentration ; Immunosuppression ; Insulin* ; Islets of Langerhans Transplantation ; Islets of Langerhans* ; Temefos ; Tissue Donors

PURPOSE: Epithelial barrier dysfunction is involved in the pathophysiology of periodontitis and oral lichen planus. Estrogens have been shown to enhance the physical barrier function of intestinal and esophageal epithelia, and we aimed to investigate the effect of estradiol (E2) on the regulation of physical barrier and tight junction (TJ) proteins in human oral epithelial cell monolayers. METHODS: HOK-16B cell monolayers cultured on transwells were treated with E2, an estrogen receptor (ER) antagonist (ICI 182,780), tumor necrosis factor alpha (TNFα), or dexamethasone (Dexa), and the transepithelial electrical resistance (TER) was then measured. Cell proliferation was measured by the cell counting kit (CCK)-8 assay. The levels of TJ proteins and nuclear translocation of nuclear factor (NF)-κB were examined by confocal microscopy. RESULTS: E2 treatment increased the TER and the levels of junctional adhesion molecule (JAM)-A and zonula occludens (ZO)-1 in a dose-dependent manner, without affecting cell proliferation during barrier formation. Treatment of the tight-junctioned cell monolayers with TNFα induced decreases in the TER and the levels of ZO-1 and nuclear translocation of NF-κB. These TNFα-induced changes were inhibited by E2, and this effect was completely reversed by co-treatment with ICI 182,780. Furthermore, E2 and Dexa presented an additive effect on the epithelial barrier function. CONCLUSIONS: E2 reinforces the physical barrier of oral epithelial cells through the nuclear ER-dependent upregulation of TJ proteins. The protective effect of E2 on the TNFα-induced impairment of the epithelial barrier and its additive effect with Dexa suggest its potential use to treat oral inflammatory diseases involving epithelial barrier dysfunction.
Architectural Accessibility ; Cell Count ; Cell Proliferation ; Dexamethasone ; Electric Impedance ; Epithelial Cells ; Estradiol ; Estrogens ; Humans ; Junctional Adhesion Molecule A ; Junctional Adhesion Molecules ; Lichen Planus, Oral ; Microscopy, Confocal ; NF-kappa B ; Periodontitis ; Tight Junctions ; Tumor Necrosis Factor-alpha ; Up-Regulation

The intestine is a unique organ inhabited by a tremendous number of microorganisms. Intestinal epithelial cells greatly contribute to the maintenance of the symbiotic relationship between gut microbiota and the host by constructing mucosal barriers, secreting various immunological mediators and delivering bacterial antigens. Mucosal barriers, including physical barriers and chemical barriers, spatially segregate gut microbiota and the host immune system to avoid unnecessary immune responses to gut microbes, leading to the intestinal inflammation. In addition, various immunological mediators, including cytokines and chemokines, secreted from intestinal epithelial cells stimulated by gut microbiota modulate host immune responses, maintaining a well-balanced relationship between gut microbes and the host immune system. Therefore, impairment of the innate immune functions of intestinal epithelial cells is associated with intestinal inflammation.
Antigens, Bacterial ; Architectural Accessibility ; Chemokines ; Cytokines ; Epithelial Cells* ; Gastrointestinal Microbiome ; Homeostasis* ; Immune System ; Inflammation ; Intestines

The skin functions as a physical barrier against entry of pathogens while concomitantly supporting a myriad of commensal organisms. The characterization of these microbial communities has enhanced our knowledge of the ecology of organisms present in normal skin, and studies have begun to illuminate the intimate relationship between the host and resident microbes. The cutaneous innate and adaptive immune responses can modulate skin microbiota, while simultaneously, the microbiota educates the host immune system. A crucial element of the innate immune response is mast cells, which reside strategically in tissues that are commonly exposed to the external environment, such as the skin and mucosae. Mast cells are present on the frontline of defense against pathogens, suggesting they may play an important role in fostering the host-microbiota relationship. In this review, we highlight findings regarding the interaction between skin microbiota and mast cells and the resulting outcomes in skin homeostasis.
Architectural Accessibility ; Ecology ; Foster Home Care ; Homeostasis ; Immune System ; Immunity, Innate ; Mast Cells* ; Microbiota* ; Mucous Membrane ; Skin*

The skin functions as a physical barrier against entry of pathogens while concomitantly supporting a myriad of commensal organisms. The characterization of these microbial communities has enhanced our knowledge of the ecology of organisms present in normal skin, and studies have begun to illuminate the intimate relationship between the host and resident microbes. The cutaneous innate and adaptive immune responses can modulate skin microbiota, while simultaneously, the microbiota educates the host immune system. A crucial element of the innate immune response is mast cells, which reside strategically in tissues that are commonly exposed to the external environment, such as the skin and mucosae. Mast cells are present on the frontline of defense against pathogens, suggesting they may play an important role in fostering the host-microbiota relationship. In this review, we highlight findings regarding the interaction between skin microbiota and mast cells and the resulting outcomes in skin homeostasis.
Architectural Accessibility ; Ecology ; Foster Home Care ; Homeostasis ; Immune System ; Immunity, Innate ; Mast Cells* ; Microbiota* ; Mucous Membrane ; Skin*