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Background Mucociliary transport function in the airway mucosa is essential for maintaining a clean mucosal surface. This function is impaired in upper and lower airway diseases. Nasal polyps are a typical pathological feature of prolonged rhinosinusitis. Like the ordinary nasal mucosa, nasal polyps have a ciliated pseudostratified epithelium with vigorous ciliary beating. We herein measured ex vivo mucociliary transport velocity (MCTV) and ciliary beat frequency (CBF) and explored the expressions of planar cell polarity (PCP) proteins in nasal polyps in comparison with turbinate mucosae. Methods Inferior turbinates and nasal polyps were collected from patients with chronic rhinosinusitis during endoscopic sinonasal surgery. Ex vivo MCTV and CBF were measured using a high-speed digital imaging system. Expressions of PCP proteins were explored by fluorescence immunohistochemistry and quantitative RT-PCR. Results The MCTV of nasal polyps was significantly lower than that of the turbinates (7.43±2.01 vs. 14.56±2.09μm/s; P=0.0361), whereas CBF did not differ between the two tissues. The MCTV vector was pointed to the posteroinferior direction in all turbinates with an average inclination angle of 41.0 degrees. Immunohistochemical expressions of Dishevelled-1, Dishevelled-3, Frizzled3, Frizzled6, Prickle2 and Vangl2 were lower in the nasal polyps than in the turbinates. The expression levels of mRNAs for Dishevelled-1, Dishevelled-3 and Frizzled3 in the nasal polyps were also decreased in comparison with the turbinates. Conclusions These results indicate that ciliary transport in nasal polyps is impaired although vigorous ciliary beating is maintained, and that the impairment may be caused by a decrease in Dishevelled/Frizzled proteins and resultant PCP disarrangement.

Background: Nasal breathing is important for maintaining physiological respiration. However, airflow in the nasal cavity has an inherent cooling effect and may suppress ciliary beating, an essential frontline defense in the airway. Nasal airflow is thought to be perceived by transient receptor potential (TRP) M8, a thermoreceptor for cool temperatures. We herein investigated the effect of the activation of thermosensitive TRPs for cool/cold temperatures on ciliary beating and searched for a compensatory mechanism that maintains ciliary beating against the fall of temperature in the human nasal mucosa. Methods and Results: Inferior turbinates were collected from patients with chronic hypertrophic rhinitis, and ex vivo ciliary beat frequency (CBF) was immediately measured using a high-speed digital video camera attached to a phase-contrast light microscope. The samples were also subjected to fluorescence immunohistochemistry and real-time RT-PCR for TRPA1/TRPM8. CBF was significantly increased by adding either cinnamaldehyde (TRPA1 agonist) or l-menthol (TRPM8 agonist), and this increase was inhibited by pannexin-1 blockers, carbenoxolone and probenecid. Immunohistochemistry detected TRPA1 and TRPM8 on the epithelial surface and in the submucosal nasal glands. Expressions of mRNAs for these receptors were confirmed by real-time RT-PCR. Conclusions: These results indicate the stimulatory effect of the activation of TRPA1/TRPM8 on ciliary beating in the nasal mucosa, which would be advantageous to maintain airway mucosal defense under normal nasal breathing. This stimulatory effect is likely to be mediated by pannexin-1. Understanding the regulatory mechanism of airway ciliary beating should aid in the development of new, effective treatments for intractable airway diseases. BackgroundNasal breathing is important for maintaining physiological respiration. However, airflow in the nasal cavity has an inherent cooling effect and may suppress ciliary beating, an essential frontline defense in the airway. Nasal airflow is thought to be perceived by transient receptor potential (TRP) M8, a thermoreceptor for cool temperatures. We herein investigated the effect of the activation of thermosensitive TRPs for cool/cold temperatures on ciliary beating and searched for a compensatory mechanism that maintains ciliary beating against the fall of temperature in the human nasal mucosa.

Myringoplasty is one of the basic procedures in otologic surgery, and is important to achieve good hearing outcome. The temporal fascia is most widely used and considered to be a stable graft in this procedure, although 10-20% of patients develop reperforation after surgery, which is often hard to repair, even by revision surgery. We herein conducted revision myringoplasty using a cartilage graft to repair postoperative reperforation in 7 patients (8 ears) with chronic otitis media. The patients were 3 males and 4 females, aged 13-80 years with an average of 53.9 years. A cartilage graft was harvested from the tragus, sliced in 0.3 mm thickness with perichondrium attached on one side, and trimmed into an appropriate shape and size. The graft was then underlaid beneath the perforation and fixed with fibrin glue. The operation was Wullstein type I tympanoplasty in 5 ears and myringoplasty in 3 ears, using the temporal fascia in 7 ears and subcutaneous tissue in 1 ear. The postoperative follow-up period ranged from 16 to 44 months with an average of 30.0 months. Perforation of the tympanic membrane was successfully closed in 7 ears (87.5%). Hearing outcome was judged successful in 5 ears (62.5%) according to the criteria of the Otological Society of Japan (postoperative hearing level30 dB, hearing gain15 dB, or postoperative air-bone gap15 dB). These results indicate that cartilage is a stable and reliable graft material for revision myringoplasty to repair postoperative reperforation in patients with chronic otitis media.

Tonsillectomy is one of the prevailing treatments for IgA nephropathy. This retrospective study aimed to elucidate prognostic factors for the postoperative kidney function of tonsillectomized patients with IgA nephropathy. Forty consecutive patients with IgA nephropathy who underwent tonsillectomy in our department between 1999 and 2008 were enrolled. They were 21 men and 19 women with ages ranging 14-52 years with an average age of 25.5 years. The patients were classified into remission and non-remission groups based on their kidney function assessed 1 year after surgery according to the clinical guidelines for IgA nephropathy of the Japanese Society of Nephrology. Patients' profiles and preoperative physical findings/laboratory data in the remission group were then compared with those in the non-remission group. The remission and non-remission groups included 13 and 27 patients, respectively. The remission group showed a significantly shorter interval between onset to surgery (2.3 +/- 2.1 vs. 5.0 +/- 6.7 years; p = 0.032), a lower diastolic blood pressure (66 +/- 13 vs. 75 +/- 17 mmHg; p = 0.040), a higher level of serum total protein (7.6 +/- 0.5 vs. 7.0 +/- 0.7 mg/dl; p = 0.015), and a higher degree of tonsillar hypertrophy (I degrees: II degrees: III degrees = 5 : 8: 0 vs. 21 : 6 : 0; p = 0.033) in comparison with the non-remission group. Multiple logistic regression analysis also revealed that patients with a higher level of serum total protein and those with a higher degree of tonsillar hypertrophy were more likely to recover. We should carefully consider these prognostic factors when indicating tonsillectomy for the treatment of IgA nephropathy.

18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a powerful tool for the detection of malignant tumors. We herein reported a case of cervical metastasis from unknown primary. Primary tumor was successfully diagnosed by FDG-PET. A 70-year-old man presented with a right-sided cervical lymph node swelling. Fine needle aspiration cytology in the previous hospital showed class III atypia, however, the primary tumor was not found by physical examination, fiberscopy, computed tomography (CT), or magnetic resonance imaging. Open biopsy of the neck demonstrated that the lesion was metastatic squamous cell carcinoma, and he subsequently underwent neck dissection on the affected side. FDG-PET and PET/CT after surgery revealed demonstrated uptake in the right piriform recess of the hypopharynx. The patient was eventually referred to our department, and underwent biopsy of the piriform recess via direct endoscopy. Histopathological diagnosis was the poorly-differentiated squamous cell carcinoma, and then he received radical radiotherapy of 72Gy to the whole neck. There was no evidence of recurrence on FDG-PET performed four months after radiation. The literature on the clinical usefulness of FDG-PET for the diagnosis of head and neck cancers were reviewed.

We report a rare case of schwannoma arising from the pharyngeal branch of the vagus nerve. An 18-year-old woman presented with an egg-sized nontender upper cervical swelling. Computed tomography and magnetic resonance imaging (MRI) revealed a well-defined tumor measuring 50mm in its major axis in the left carotid space. The tumor was moderately enhanced, and showed hypointensity and isointensity on T1- and T2-weighted MRI, respectively. Otorhinolaryngological findings were otherwise normal. A schwannoma was most likely suspected, and she underwent transcervical resection of the tumor. A cordlike strand connected to the cephalad end of the tumor was severed, while both the vagus and hypoglossal nerves were identified and preserved. The histopathological diagnose is schwannoma. After surgery, the patient manifested a curtain sign toward the unaffected side without showing vocal cord palsy or Homer's syndrome, indicating that the tumor had arisen from the pharyngeal branch of the vagus nerve. Clinical characteristics of schwannomas in the carotid space were reviewed.

Basaloid squamous cell carcinoma is a rare and high-grade variant of squamous cell carcinoma. Here we report two cases of this tumor of the head and neck. The first case was a 71-year-old man who presented with an 8-month history of foreign body sensation in the throat. Physical examination and computed tomography demonstrated a tumor measuring 17mm in diameter on the right lateral pharyngeal wall. He underwent tumor resection via lateral pharyngotomy followed by reconstruction with a sternocleidomastoid myocutaneous flap. The histopathological diagnosis was basaloid squamous cell carcinoma. Because he manifested recurrent aspiration pneumonia postoperatively, total laryngectomy was eventually performed. The second case was a 41-year-old man who complained of persistent oral pain. An ulcerated lesion measuring 10×5mm was seen on the left buccal mucosa, and squamous cell carcinoma was suspected through biopsy. He underwent transoral resection, and the lesion was histopathologically diagnosed as basaloid squamous cell carcinoma. Both patients are currently free from disease about one and a half years after surgery. The pathology, clinical characteristics, and treatment of basaloid squamous cell carcinoma are bibliographically reviewed.

A case of papillary carcinoma arising from a thyroglossal duct cyst is reported. A 43-year-old man was referred to our clinic with an anterior cervical mass. CT scan and MRI imaging revealed a ring-enhanced cystic mass in his anterior neck, while ultrasonography showed an irregular echo in the mass. He was preoperatively diagnosed with thyroglossal duct cyst, and underwent resection of the mass by Sistrunk's procedure. Histopathological examination of the surgical specimen showed papillary carcinoma in the thyroglossal duct cyst. Because the histological findings indicated that the tumor had been completely resected, no additional treatment was given. His postoperative course was uneventful, and the patient is currently free from disease 3 years after surgery.It is known that carcinoma, mostly papillary carcinoma, occurs more frequently in thyroglossal duct cysts than in the ordinary thyroid gland. Ultrasonography is a sensitive and useful method for detecting calcified lesions for the diagnosis of this disease. The epidemiology and clinical characteristics of papillary carcinoma associated with thyroglossal duct cyst were reviewed in the literature.

Sleep apnea syndrome (SAS) is a risk factor in lifestyle-related disease known to be closely associated with traffic and occupational accidents. Because of its high morbidity in middle-aged men, early diagnosis and management by industrial physicians are important. We clarified the degree of knowledge and concern about SAS among industrial physicians. We e-mailed questionnaires to 199 industrial physicians belonging to the Industrial Medical Promotion Society, and Most answered that industrial received responses from 51 (40 contracted and 11 part-time industrial physicians). physicians should participate in the management of SAS to prevent doze accidents, to control lifestyle-related diseases, to judge vocational fitness, and to lower economical expense. Fewer than 30% of physicians had conducted educational activities, and even fewer had practiced interviews and screening for SAS. Financial difficulty, lack of specialized hospitals for SAS, lack of labor, and a lack of concern among executives are major obstacles to SAS screening for employees. We concluded that, despite the concern industrial physicians, SAS is practically disregarded in their work. Cost-and time-effective screening and guidelines for employees with SAS should be established to facilitate the management of SAS by industrial physicians.

Changing the sleep position from supine to non-supine is a simple but effective treatment for some patients with sleep apnea syndrome. In the present study, we compared the clinical data for good responders (GRs), those who responded well to the sleep position change, with those for poor responders (PRs), and also evaluated the effect of surgical treatment on the positional improvement of ventilation in the PR group. Forty-one adult patients with sleep apnea syndrome (mean age: 47.1 years, mean obesity index: 125.8%) were divided into two groups based on their polysomnographic responses to sleep position change. Thirty-two patients were classified as the GR group, whose apnea-hypopnea index (AHI) in the non-supine position declined to less than half of their AHI in the supine position, and nine whose non-supine AHI remained greater than half of their supine AHI were classified as the PR group. The AHI and the desaturation index (DI) for the PR group were significantly higher than those for the GR group, and the obesity index was also higher in the PR group. For the eight PRs who had surgical therapy, their polysomnographic data improved much more in the non-supine position than in the supine position. Of six patients whose total AHI was still 10 or more after surgery, four changed into GRs. The combination of surgery and sleep position change seemed to be an effective treatment even for patients with a little improvement before surgery.

We studied the usefulness of cephalometry and pharyngeal findings in determining efficient primary diagnosis of obstructive sleep apnea syndrome (OSAS). Subjects were 171 adult men with sleep-disordered breathing, who underwent cephalometry and polysomnography (PSG) and had pharyngeal findings evaluated by modified Mallampati grade (MMP) and palatine tonsil size. An apnea-hypopnea index (AHI) ofor = 15 in PSG was considered to indicate OSAS. We analyzed the correlation between AHI and other parameters and conducted stepwise multiple regression analysis to predict AHI, and studied the screening performance of prediction equations using a receiver operating characteristic (ROC) curve. Of the 8 cephalometric parameters examined, the length of the soft palate (PNS-P; p = 0.011) and the distance from the mandibular plane to the hyoid bone (MP-H; p0.001) correlated significantly with AHI. Two indices of the pharyngeal finding and body mass index (BMI) also significantly correlated with the AHI (MMP; p0.001, tonsil size; p = 0.005, BMI; p0.001). We next set up three prediction equations including (a) two significant cephalometric parameters (PNS-P and MP-H), (b) two pharyngeal indices (MMP and tonsil size), or (c) both. BMI was included in all three. ROC curve analysis showed that the screening performance of prediction equations was (c)(a)(b). Sensitivity and of equation (c) with a cutoff of 15 were 0.95 and specificity 0.25. These results indicate that both cephalometric parameters and pharyngeal indices should be included in conducting an efficient primary diagnosis for OSAS.

A quantitative characterization of the degree of agglomeration of the particles in multi-phase polymer alloy systems has been carried out. A numerical agglomeration distribution function and its 4 moments were calculated from SEM photographs using computer image analysis. In a model alloy system of PC/MBS a good correlation between the degree of agglomeration of the MBS and of the impact strength has been obtained. In PBT/PC alloys, the effect of mixing conditions in the heating rolls on the distribution of particle diameter, ligament thickness between particles and degree of agglomeration have been examined. A similar analysis has been carried out on on the PBT/PC alloys mixed with an extruder. The results showed that increasing agglomeration of the dispersed phase (PC) reduced the impact strength when the matrix was composed of high molecular weight PBT.

Infants at day care centers tend to contract repetitive upper respiratory infections and prolonged otitis media. The increase in antimicrobial-resistant bacteria, particularly in infants, has given rise to a stubborn therapeutic problem. We studied the nasopharyngeal carriage and drug resistance to Haemophilus influenzae (H. influenzae) and Streptococcus pneumoniae (S. pneumoniae), the most common pathogens of upper respiratory infections, in infants at day care centers. Nasopharyngeal cultures of infants between the ages of 0 and 6 years were conducted at two day care centers in July 2004 ("summer"; n=183), and in February 2005 ("winter"; n=182). Isolated H. influenzae and S. pneumoniae were subjected to antibiotic susceptibility tests by broth microdilution. We also conducted an otolaryngological examination and a survey on past and life histories. H. influenzae in summer (38.3%) increased significantly in winter (57.7%). Beta-lactamase-negative and positive ampicillin-resistant H. influenzae (BLNAR+ BLPAR) in summer decreased significantly in winter. S. pneumoniae did not differ in summer (42.1%) or in winter (43.4%). Penicillin-resistant and intermediate S. pneumoniae (PRSP+PISP) was 41.3% in summer and decreased significantly to 19.0% in winter. BLNAR + BLPAR and PRSP + PISP differed with the day care center. In otolaryngological examination, rhinosinusitis was commonest (28.4% in summer and 30.8% in winter), followed by allergic rhinitis (8.7% in summer and 6.0% in winter) and otitis media (8.2% in summer and 6.0% in winter). Tonsillitis was minor (0.5% in both seasons). Rhinosinusitis in winter was significantly higher in carriers of H. influenzae and/or S. pneumoniae than in non carriers (36.4% versus 16.0%). Breast-fed infants tended to have less otitis media than bottle-fed infants (38.2% versus 52.9%). H. influenzae and/or S. pneumoniae plateaued (75-80%) after 12 months in day care centers. These results suggest that infants attending day care centers are immediately colonized by H. influenzae and S. pneumoniae in the nasopharynx after entering the centers. Nasopharyngeal drug-resistant H. influenzae and S. pneumoniae varied during the seasons and between day care centers. Further prospective studies are needed to determine upper respiratory tract infection in infants at day care centers and to evaluate carriage, epidemiology, and the drug-resistance rates of these pathogens.

The mechanism of the reactions of arylthiotrimethylsilanes with carboxylic acids has been studied kinetically. The reaction was found to obey a second-order kinetic equation. The substituent effects of the aryl moiety (ρ=−2.4) and of the silicon atom, the hydrogen-deuterium kinetic isotope effect of the acid (kH/kD=3) were observed. A mechanism involving the 5-coordination of the silicon atom prior to the rate-determining protona-tion of the sulfur atom has been suggested for the reaction. A remarkable base catalysis was observed. The formation of the coordinated intermediate has been suggested to be the slow step in the presence of a bese.

The acyloxy exchange reactions of acyloxysilane with carboxylic acids have been studied kinetically. The rate of reaction has been found to proceed faster with a stronger attacking acid and more basic leaving acyloxy group. The rate was markedly accelerated by the addition of base. The steric effect due to substituents on the silicon atom and hydrogen-deuterium kinetic isotope effects have been examined. A mechanism involving the 5-coordination of the silicon atom prior to the rate-determining proton transfer has been suggested.