Objective: Fiberoptic endoscopic evaluation of swallowing (FEES) is a standard diagnostic tool for swallowing disorders. However, it has not been used frequently in Korea because of the long test time, low cost, and the absence of a standard evaluation system. The purpose of this study was to suggest a standard fill-out form for the FEES result. Methods: From February 2019 to June 2020, a total of 98 FEES tests were performed by an otolaryngologist (JYJ) at the Wonkwang University Hospital. After the exclusion of 68 cases, 30 cases were analyzed twice by 4 raters with over 5 years of experience as otolaryngologists working in various hospitals. The results were measured for the rater’s test-retest reliability and inter-rater consistency. Results: Cohen’s kappa values for measuring the intra-rater consistency of the four raters were 0.984, 0.887, 0.848, and 0.930, respectively, meaning very good alignment of 0.8 or more, respectively. The Fleiss Kappa value for measuring inter-rater consistency was 0.276, meaning ‘fair’ for values of 0.2 or more. To examine consistency, an intraclass correlation coefficient (ICC) analysis conducted by assuming the grading score to be a constant continuous variable gave an ICC value of 0.729 (P＜0.001), showing a very reliable tendency. Conclusion In this study, all the items of the fill-out form were rated using a three-step grading scale, so the degree of agreement was high when performed twice by the same rater, but the degree of agreement among raters was relatively low. Therefore, our fill-out form for FEES will be useful in evaluating the improvement of a patient over the course of clinical treatment.

Background and Objectives: The quality of life after thyroidectomy, such as voice change, is considered to be as important as control of the disease. In this study, we aimed to evaluate changes in both subjective and objective voice parameters after thyroidectomy resulting in normal morbidity of the vocal cords.Materials and Method In this prospective cohort study, 204 patients who underwent thyroidectomy with or without central neck dissection at a single referral center from Feb 2015 to Aug 2016 were enrolled. All patients underwent prospective voice evaluations including both subjective and objective assessments preoperatively and then at 2 weeks, 3, 6, and 12 months postoperatively. Temporal changes of the voice parameters were analyzed. Results: Values of the subjective assessment tool worsened during the early postoperative follow-up period and did not recover to the preoperative values at 12 months postoperatively. The maximal phonation time gradually decreased, whereas most objective parameters, including maximal vocal pitch (MVP), reached preoperative values at 3–6 months postoperatively. The initial decrease in MVP was significantly greater in patients undergoing total thyroidectomy, and their MVP recovery time was faster than that of patients undergoing lobectomy (p=0.001). Patients whose external branch of the superior laryngeal nerve was confirmed intact by electroidentification showed no difference in recovery speed compared with patients without electroindentification (p=0.102), although the initial decrease in MVP was lower with electroidentification. Conclusion Subjective assessment in voice quality and maximal phonation time after thyroidectomy did not show recovery to preoperative values. Aggravation of MVP was associated with surgical extent and electroidentification.

Purpose: There are many studies on the indications and efficacy of splint therapy commonly used in patients with temporomandibular disorders (TMD). However, there have been no studies on the splint weaning in terms of the splint use tapering period in relation to symptom improvement of TMD. This retrospective study aims to analyze a proper splint weaning method in patients with TMD based on symptom improvement. Materials and Methods: The authors examined 130 TMD patients with TMJ disorders, masticatory muscle disorders, and clenching/bruxism who had received splint therapy (occlusion stabilization splint, anterior positioning splint) of patients who visited the Department of Orofacial Pain and Oral Medicine at Yonsei University Dental Hospital from 2015 to 2020. They were evaluated according to the method to wean splints. Results: The mean splint therapy period was 29.0 months, during which patients wore splints 7 days a week for 8.4 months, 3 - 4 days a week for 9.5 months, and finally 1 - 2 days a week for 11.1 months (a total of 29.0 months, about 2.5 years). Conclusion It seems that TMD symptoms can be alleviated and side effects such as occlusal change can be minimized if patients wear a splint 7 days a week for the first 6 months, followed by 3 - 4 days a week for the next 6 to 18 months, and finally 1 - 2 days a week after 18 months.

BACKGROUND/AIMS: Since patients with human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) have favorable outcomes after treatment, treatment de-escalation for these patients is being actively investigated. However, not all HPV-positive HNSCCs are curable, and some patients have a poor prognosis. The purpose of this study was to identify poor prognostic factors in patients with HPV-positive HNSCC. METHODS: Patients who received a diagnosis of HNSCC and tested positive for HPV from 2000 to 2015 at a single hospital site (n = 152) were included in this retrospective analysis. HPV typing was conducted using the HPV DNA chip assay or liquid bead microarray system. Expression of p16 in the tumors was assessed by immunohistochemistry. To determine candidate factors associated with overall survival (OS), univariate and multivariable Cox regression analyses were performed. RESULTS: A total of 152 patients with HPV-positive HNSCC were included in this study; 82.2% were male, 43.4% were current or former smokers, and 84.2% had oropharyngeal cancer. By univariate analysis, old age, performance status ≥ 1, non-oropharyngeal location, advanced T classification (T3–4), and HPV genotype 18 were significantly associated with poor OS. By multivariable analysis, performance status ≥ 1 and non-oropharyngeal location were independently associated with shorter OS (hazard ratio [HR], 4.36, p = 0.015; HR, 11.83, p = 0.002, respectively). Furthermore, HPV genotype 18 positivity was also an independent poor prognostic factor of OS (HR, 10.87, p < 0.001). CONCLUSIONS Non-oropharyngeal cancer, poor performance status, and HPV genotype 18 were independent poor prognostic factors in patients with HPV-positive HNSCC. Patients with these risk factors might not be candidates for de-escalation treatment.

BACKGROUND: It is difficult to correctly diagnose follicular neoplasms (FNs) on fine-needle aspiration cytology (FNAC) because it shares many cytological features with other mimicking lesions. The aim of this study was to identify the cytological features that differentiate FNs from mimicking lesions. METHODS: We included the cytological slides from 116 cases of thyroid FN diagnosed on FNAC, and included their subsequent histological diagnoses. We evaluated the cytological architectural pattern and nuclear features of the lesions according to their histological groups. RESULTS: The final histological diagnoses of the 116 cases varied, and included 51 FNs (44%), 47 papillary thyroid carcinomas (40%) including follicular variant, and seventeen cellular nodular hyperplasias (15%). Regardless of the final histological diagnosis, microfollicular pattern was observed in most cases. On the other hand, trabecular pattern was identified in 34% of FNs, but not in any other lesions. Additionally, elongated nuclei and ground glass chromatin were found in only some papillary thyroid carcinomas. CONCLUSIONS: This study shows that the trabecular pattern is a representative cytological feature of FNs that can be used to distinguish FNs from mimicking lesions. In addition, nuclear shape and chromatin pattern can be used to further confirm the diagnosis of FNs from mimicking lesions through FNAC.
Biopsy, Fine-Needle ; Chromatin ; Diagnosis ; Diagnosis, Differential ; Glass ; Hand ; Hyperplasia ; Thyroid Gland ; Thyroid Neoplasms

Familial Parkinson's disease (PD) has been linked to point mutations and duplication of the α-synuclein (α-syn) gene. Mutant α-syn expression increases the vulnerability of neurons to exogenous insults. In this study, we developed a new PD model in the transgenic mice expressing mutant hemizygous (hemi) or homozygous (homo) A53T α-synuclein (α-syn Tg) and their wildtype (WT) littermates by treatment with sub-toxic (10 mg/kg, i.p., daily for 5 days) or toxic (30 mg/kg, i.p., daily for 5 days) dose of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Tyrosine hydroxylase and Bcl-2 levels were reduced in the α-syn Tg but not WT mice by sub-toxic MPTP injection. In the adhesive removal test, time to remove paper was significantly increased only in the homo α-syn Tg mice. In the challenging beam test, the hemi and homo α-syn Tg mice spent significantly longer time to traverse as compared to that of WT group. In order to find out responsible proteins related with vulnerability of mutant α-syn expressed neurons, DJ-1 and ubiquitin enzyme expressions were examined. In the SN, DJ-1 and ubiquitin conjugating enzyme, UBE2N, levels were significantly decreased in the α-syn Tg mice. Moreover, A53T α-syn overexpression decreased DJ-1 expression in SH-SY5Y cells. These findings suggest that the vulnerability to oxidative injury such as MPTP of A53T α-syn mice can be explained by downregulation of DJ-1.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine ; Adhesives ; Animals ; Apoptosis ; Dopamine* ; Dopaminergic Neurons* ; Down-Regulation* ; Hominidae ; Humans ; Mice* ; Mice, Transgenic ; Neurons ; Parkinson Disease ; Point Mutation ; Synucleins ; Tyrosine 3-Monooxygenase ; Ubiquitin

PURPOSE: Recent studies have shown that interferon-gamma-inducible protein of 10 kDa (IP-10/CXCL10) levels is increased in acute bronchiolitis and asthma. The aim of this study was to examine the levels of IP-10 in children with wheezing and whether it correlates with other clinical variables. METHODS: A total of 62 subjects children were hospitalized for lower respiratory tract infection with wheezing and visited the Emergency Department due to an acute exacerbation of asthma. IP-10 levels were measured using enzyme-linked immunosorbent assay in the serum collected at admission. Serum IP-10 levels were evaluated for the relationships with age, sex, blood eosinophils counts, acute phase reactant, allergic sensitization, history of wheezing, and chest X-ray findings. RESULTS: Age showed a significant negative correlation with serum IP-10 levels (P=0.002). The serum levels of IP-10 were also significantly increased in patients with pneumonic infiltration on X-rays compared to those with normal or hyperinflation (P<0.009). There was no significant difference in the serum IP-10 level according to the other factors, including allergic sensitization. CONCLUSION: Serum IP-10 is significantly associated with inflammation of the lung and age, but not with allergic inflammation.
Asthma ; Bronchiolitis ; Chemokine CXCL10* ; Child* ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Eosinophils ; Humans ; Inflammation ; Lung ; Respiratory Sounds* ; Respiratory Tract Infections ; Thorax

PURPOSE: This study aimed to determine the incidence, etiology, prognostic factors, and outcome of acute respiratory distress syndrome (ARDS) in children and to provide epidemiological data of children with ARDS treated at the pediatric intensive care unit (PICU) of a single center in Korea. METHODS: We conducted a retrospective medical chart review of 19 children diagnosed with ARDS at the PICU of The Catholic University of Korea, Seoul St. Mary's Hospital, between March 2009 and February 2012. RESULTS: Of the 334 PICU patients, 19 (5.6%) satisfied the American-European Consensus Conference definition of ARDS. Thirteen patients with ARDS died (mortality rate, 68.4%). Pneumonia was the most common cause of ARDS and observed in 10 patients (52.6%). There were significant differences between survivors and nonsurvivors in the PaO2/FiO2 ratio and the number of organ failure. The mortality rate was significantly higher in patients with a baseline PaO2/FiO2 ratio < or =100 mmHg than in those with a baseline PaO2/FiO2 ratio>100 mmHg (84.6% vs. 33.3%, P=0.046). We observed that a higher number of organ failure during the PICU stay, resulted in a higher mortality rate (P=0.037). Multiple logistic regression analysis showed that the PaO2/FiO2 ratio (adjusted odds ratio, 0.958) was independently associated with the increased risk of death after controlling for the number of organ failure. CONCLUSION: The mortality rate of ARDS in children was 68.4% in this study, a higher rate than those reported in other national and international studies. The PaO2/FiO2 ratio at the time of ARDS onset was a helpful prognostic factor for predicting the mortality rate of children with ARDS.
Child* ; Consensus ; Humans ; Incidence ; Intensive Care Units ; Korea ; Logistic Models ; Mortality ; Odds Ratio ; Pneumonia ; Respiratory Distress Syndrome, Adult* ; Retrospective Studies ; Seoul ; Survivors

PURPOSE: Children admitted to pediatric intensive care unit (PICU) with respiratory tract disease, often have a tendency to be readmitted to PICU with disease progression. We studied the risk factors for readmission to PICU, with respiratory disease progression. METHODS: Among 286 children admitted to Seoul St. Mary's Hospital PICU from April 2009 to March 2012, 129 children admitted with respiratory tract disease were enrolled. We grouped the children readmitted to PICU with respiratory tract disease progression within 2 weeks (readmission group), and the others (control group). We compared basic and respiratory tract disease characteristics at initial PICU admission between them, by retrospective chart review. RESULTS: Among 129 children, 8 were included in the readmission group, and 121 in the control group. Mortality and underlying disease incidence were higher in the readmission group (P=0.003 and P=0.033, respectively). The readmission group showed higher parenchymal lung disease incidence, and lower initial saturation by pulse oxymeter (SpO2)/fraction of inspiratory oxygen (FiO2), despite underlying disease influence (P=0.035 and P=0.041, respectively). Logistic regression on the underlying disease and respiratory variables showed no single factor with a significantly independent influence on readmission, but parenchymal lung disease had more independent influence. CONCLUSION: For PICU readmission with respiratory tract disease progression, parenchymal lung disease and lower initial SpO2/FiO2 can be a risk factor despite underlying disease influence. Underlying disease and each respiratory characteristic were not significantly independent risk factors, suggesting a correlation of factors. But, parenchymal lung disease can be a more independent risk factor.
Child* ; Disease Progression ; Humans ; Incidence ; Intensive Care Units* ; Logistic Models ; Lung Diseases ; Mortality ; Oxygen ; Patient Readmission ; Respiratory Tract Diseases* ; Retrospective Studies ; Risk Factors* ; Seoul

Salivary function in mammals may be defective for various reasons, such as aging, Sjogren's syndrome or radiation therapy in head and neck cancer patients. Recently, tissue-specific stem cell therapy has attracted public attention as a next-generation therapeutic reagent. In the present study, we isolated tissue-specific stem cells from the human submandibular salivary gland (hSGSCs). To efficiently isolate and amplify hSGSCs in large amounts, we developed a culture system (lasting 4-5 weeks) without any selection. After five passages, we obtained adherent cells that expressed mesenchymal stem cell surface antigen markers, such as CD44, CD49f, CD90 and CD105, but not the hematopoietic stem cell markers, CD34 and CD45, and that were able to undergo adipogenic, osteogenic and chondrogenic differentiation. In addition, hSGSCs were differentiated into amylase-expressing cells by using a two-step differentiation method. Transplantation of hSGSCs to radiation-damaged rat salivary glands rescued hyposalivation and body weight loss, restored acinar and duct cell structure, and decreased the amount of apoptotic cells. These data suggest that the isolated hSGSCs, which may have characteristics of mesenchymal-like stem cells, could be used as a cell therapy agent for the damaged salivary gland.
Amylases/genetics/metabolism ; Animals ; Antigens, CD/genetics/metabolism ; Apoptosis ; Cell Differentiation ; Humans ; Male ; Mesenchymal Stromal Cells/*cytology/metabolism ; Radiation Injuries, Experimental ; Rats ; Rats, Wistar ; *Regeneration ; Salivary Glands/cytology/injuries/physiology/*surgery ; *Salivation ; *Stem Cell Transplantation