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Mammary analog secretory carcinoma (MASC) is a recently identified neoplasm of the salivary glands, which harbors the distinctive ETV6-NTRK3 oncogenic fusion gene from other salivary malignant tumors. MASC shares morphologic characteristics with acinic cell carcinoma (AciCC) and mucoepidermoid carcinoma (MEC), and is more likely to metastasize to the regional lymph nodes. Thus differentiation among other salivary gland tumors is important. We present a rare pediatric case of parotid gland MASC in a 12-year-old girl and a review of world literature.

Nasal packing is a widely used procedure in various types of nasal surgery and the management of nasal bleeding. The purpose of this study was to evaluate a simple procedure of applying antibiotic ointment to the surface of the packing during the packing procedure. Six patients who were undergoing septomeatoplasty were enrolled in this study. All patients received postoperative antibiotics by mouth (cephalexin 500 mg 4 times daily for 7 days). In addition, all patients received bilateral nasal packing with Merocele. On one randomly chosen side, ointment containing neomycin sulfate 5 mg plus bacitracin zinc 12.5 mg was applied on the surface of the packing prior to use. On the control side of the same patient, Vaseline ointment was used instead. The packs were removed 3 days later and a 1 cm 3 piece of the packing was taken from the middle section. The samples were sent for bacteriological analysis. Tryptic soy broth was added to the samples and they were evenly dispersed on blood agar plates. After incubating overnight, colony formation was observed and recorded. The data from each group were compared using the Wilcoxon signed rank test. Among the control nasal packing side, Pseudomonas putida and Staphylococcus epidermidis were the bacteria most commonly cultured. The mean ± SD number of colony-forming units for the removed nasal packing ( n = 6) on the neomycin side and the control side of the same patient were 70 ± 105 units and 165 ± 166 units, respectively. In addition to the systemic administration of antibiotics, a significant reduction in bacterial load was achieved if a topical neomycin antibiotic ointment was applied to the nasal packing prior to use. We suggest that this simple application of topical neomycin on the nasal packing surface should be used whenever nasal packing is needed.

Butylidenephthalide (Bdph, 30~300 μM), a constituent ofLigusticum chuanxiongHort., significantly enhanced tension in isolated guinea-pig trachea. In this study, we investigate the mechanism(s) of Bdph-induced contraction in the tissue. Isolated trachea was bathed in 5 mL of Krebs solution containing indomethacin (3 μM), and its tension changes were isometrically recorded. Cromakalim (3 μM), an ATP-dependent K+channel opener, significantly antagonized the Bdph-induced enhancement of baseline tension. Bdph (300 μM) also significantly antagonized cromakalim-induced relaxation. Bdph (300 μM) did not significantly influence the antagonistic effects of glibenclamide (GBC, 1 μM) and tetraethylammonium (TEA, 8 mM) against the cromakalim-induced relaxation. However, Bdph (300 μM) and 4-aminopiridine (4-AP, 5 mM), a blocker of Kv1 family of K+channels, in combination significantly rightward shifted the log concentration-relaxation curve of cromakalim. The antagonistic effect of the combination almost equals the sum of the individual effects of Bdph and 4-AP, suggesting that the antagonistic mechanism of Bdph may be similar to that of 4-AP. All calcium channel blockers influenced neither the baseline tension nor antagonistic effect of Bdph against cromakalim. In conclusion, Bdph may be similar to 4-AP, a blocker of Kv1 family of K+channels, to enhance the baseline tension of guinea-pig trachea.

We evaluated the adhesive strength of ethyl-2-cyanoacrylate and compared the findings with those of traditional monofilament synthetic sutures. We also investigated the factors that could affect the effectiveness of cyanoacrylate bonding by skin surface modifications at the adhesion site. Using a porcine skin model, we measured the maximum load for ethyl-2-cyanoacrylate adhesive under various application conditions. When the application width was 5 mm, no differences were found in the maximum force load for one layer or two layers of ethyl-2-cyanoacrylate adhesive (3.3 ± 1.7 and 4.8 ± 1.5 N, p = 0.176). When the application width was extended to 10 mm, the maximum force load for one layer was 8.2 ± 0.6 N, which was significantly higher than for 5 mm (p

OBJECTIVES Previous studies have proposed that impaired cochlear blood perfusion and microvascular damage are important etiopathogenetic events in the development of sudden sensorineural hearing loss (SSHL). The purpose of this study was to test the hypothesis that SSHL is a risk factor for the development of erectile dysfunction (ED). STUDY DESIGN A retrospective cohort study. SETTING Population-based study of Taiwan National Health Insurance Research Database. METHODS We compared male patients newly diagnosed with SSHL between January 1, 2001, and December 31, 2006 (N = 23,212), with age-matched controls (1:2) (N = 46,424). MAIN OUTCOME MEASURES The incidence of ED at the end of 2009 was determined. RESULTS After adjusting for potential confounding factors, we found an adjusted hazard ratio (HR) of 1.942 (95% confidence interval, 1.688-2.233, p < 0.05), showing that patients with SSHL were more likely to experience ED than the control population. When stratified by patients' age, the incidence of ED was 1.90-, 2.25-, and 1.84-fold higher for SSHL-diagnosed patients 16 to 34 years old (p = 0.0408), 35 to 49 years old (p < 0.0001), and 50 to 64 years old (p < 0.0001), respectively, than in the non-SSHL group. Hypertension and chronic renal disease comorbidities in patients with SSHL seemed to be associated with an increased risk of developing ED. CONCLUSION SSHL may confer an independent risk of ED. This observation supports the assumption of the underlying vascular mechanism regarding the development of SSHL. Thus, clinicians managing SSHL patients should be aware of the potential of the development of ED. EVIDENCE LEVEL 2B.

The phosphodiesterase (PDE)4 molecule exists as two distinct conformers, PDE4H and PDE4L, which have high and low affinities, respectively, for the selective PDE4 inhibitor, rolipram. The inhibition of PDE4H and PDE4L is associated with adverse responses, such as nausea, vomiting, and gastric hypersecretion, and with anti-inflammatory and bronchodilator effects, respectively. We determined the therapeutic (PDE4H/PDE4L) ratios of hesperetin-7-O-methylether, hesperetin-5,7,3′-O-trimethylether (HTME), hesperetin-7-O-acetate, hesperetin-7,3′-O-diacetate, hesperetin-5,7,3′-O-triacetate (HTA), hesperetin-5,7,3′-O-tripropionate, hesperetin-5,7,3′-O-tributyrate, hesperetin-5,7,3′-O-triisobutyrate, and hesperetin-5,7,3′-O-tripivatate, and compared these ratios to those of hesperetin, hesperetin-7,3′-O-dimethylether, hesperidin, and hesperidin-3′-O-methylether to identify derivatives with therapeutic ratios and to characterize the structure–activity relationships among these compounds. The activities of PDE isozymes 1 through 5 were measured using a two-step procedure using [3H]adenosine 3′,5′-cyclic monophosphate or [3H]guanosine 3′,5′-cyclic monophosphate as substrates. The inhibitory concentration (IC50) for 50% of PDE4 inhibition and effective concentration (EC50) for replacing 50% of [3H]rolipram binding on high-affinity rolipram-binding sites was taken as the PDE4L and PDE4H value, respectively. The HTME and the HTA dually inhibited PDE3 and PDE4, and displayed PDE4H/PDE4L ratios of 18.3 and 20.8, respectively, suggesting that they may be candidate drugs for treating asthma and chronic obstructive pulmonary disease (COPD) because the combined inhibition of PDE3 and PDE4 has synergistically anti-inflammatory and bronchodilator effects in COPD patients. © 2013 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 102:2120–2127, 2013

Objectives/Hypothesis: This study assessed the effects of varying the electrode location on tonal discrimination and speech perception in Mandarin Chinese-speaking patients. Study Design: A controlled study with six experimental conditions. Methods: Seven Mandarin-speaking listeners who received a MED-EL cochlear implant (CI), ranging in age from 12.88 to 36.43 years (mean, 25.51 years), with an average of 5.28 years of device experience, participated this study. To evaluate the effects of electrode location, six experimental conditions each with the switch off at six different electrodes were designed. Identification tests of Mandarin lexical tones and words were performed. Results: Among experimental conditions with electrode lengths of 31, 23.8, and 16.6 mm, the CI subjects exhibited improved vowel and consonant identification in the condition of 31 mm, reflecting the apical location of electrodes. Specifically, the improvement was observed in the identification score for the vowel backness and height, as well as for the consonant place of articulation. Comparison among three settings with a same electrode length of 12.6 mm and the setting with stimulation to the midregion of the cochlea produces better words as well as the vowel and consonant identification compared with stimulation to basal and apical regions. However, no significant difference was observed for the lexical tone identification among conditions with different electrode location and stimulating region. Conclusions: Less mismatch of the frequency-to-place alignment may account for the improvement of word identification in conditions with electrodes coverage to more apical location; and in conditions where the mid-region of the cochlea were stimulated. Laryngoscope, 2012

Cryptococcosis of the larynx is rare. In this manuscript we present a case of laryngeal cryptococcosis with a clear history of pigeon exposure. Cryptococcal laryngitis may present as hoarseness without other typical symptoms, even in immunocompetent individuals.

Congenital epiglottic cyst is a rare affliction with potential for airway obstruction. A newborn boy was referred to our department for evaluation of respiratory distress and inspiratory stridor 7 h after birth. Through a transnasal fiberoptic laryngoscopy examination, a diagnosis of an obstructive upper laryngeal cyst was made. Immediate endoscopic surgery was performed 20 h after birth to completely remove the lesion. Two days after surgery, the patient resumed normal breathing pattern and showed no further episodes of stridor or airway obstruction.

Conclusions: Systemic lupus erythematosus (SLE) is associated with an increased risk of developing a head and neck malignancy (HNM). A history of SLE did not significantly impact the survival of our study cohort after cancer developed. Objectives: To examine the risk and survival rates of HNM in patients with SLE. Methods: This was a population-based, retrospective cohort study. We compared patients newly diagnosed with SLE between 2001 and 2008 (n = 8751) with age-matched controls (1:10) (n = 87 510). The incidence of HNMs at the end of 2009 was then determined. Results: We found a 2.16-fold higher risk of HNMs in patients diagnosed with SLE compared with the risk of first malignancy in the age-matched controls (incidence rate ratio, IRR = 2.16, p < 0.05). The site with the highest incidence of HNMs in SLE patients was the oral cavity (5/11, 45.45%), followed by the nasopharynx (4/11, 36.36%). SLE displayed no synergic effect on the survival of SLE patients with an HNM compared with age-matched ...

Hesperidin is present in the traditional Chinese medicine, “Chen Pi,” and recently was reported to have anti-inflammatory effects. Therefore, we were interested in comparing the effects of hesperidin and hesperidin-3′-O-methylether on phosphodiesterase inhibition and airway hyperresponsiveness (AHR) in a murine model of asthma. In the present results, hesperidin-3′-O-methylether, but not hesperidin, at 30 μmol/kg (p.o.) significantly attenuated the enhanced pause (Penh) value, suppressed the increases in numbers of total inflammatory cells, macrophages, lymphocytes, neutrophils, and eosinophils, suppressed total and OVA-specific immunoglobulin (Ig)E levels in the serum and BALF, and enhanced the level of totalIgG2ain the serum of sensitized and challenged mice, suggesting that hesperidin-3′-O-methylether is more potent than hesperidin in suppression of AHR and immunoregulation. The different potency between them may be due to their aglycons, because these two flavanone glycosides should be hydrolyzed byβ-glucosidase after oral administration. Neither influenced xylazine/ketamine-induced anesthesia, suggesting that they may have few or no adverse effects, such as nausea, vomiting, and gastric hypersecretion. In conclusion, hesperidin-3′-O-methylether is more potent in phosphodiesterase inhibition and suppression of AHR and has higher therapeutic (PDE4H/PDE4L) ratio than hesperidin. Thus, hesperidin-3′-O-methylether may have more potential for use in treating allergic asthma and chronic obstructive pulmonary disease.

Objectives/Hypothesis: To examine the risk of getting Sudden Sensorineural Hearing Loss (SSHL) among patients with chronic kidney disease (CKD). Study Design: A retrospective cohort study. Methods: Population-based representative insurance claims data were used to examine the risk of getting SSHL among patients with chronic kidney disease. Data extracted from the Taiwan National Health Insurance Research Database yielded 37,421 patients with newly diagnosed renal insufficiency and 37,421 subjects without renal insufficiency from between 2000 and 2004. Results: The incidence of SSHL at the end of 2009 was determined. The incidence of SSHL was 1.57 times higher in the CKD-carrying group compared to the incidence in the non-CKD group (10.24 vs. 6.52 per 10,000 person-years), with adjusted hazard ratio (HR) of 1.46 (95% CI = 1.194–1.787) using Cox proportional hazard regressions. Age was an independent risk factor of getting SSHL, with adjusted HRs of 2.01, 3.178, and 2.285 for age ranges of 35 ≈ 49, 50 ≈ 64 and ≥ 65 compared with age range of 0 ≈ 35. Diabetes Mellitus was another independent risk factor with HR of 1.31 (95% CI = 1.003–1.711). Conclusions: Present results suggested a significant association between CKD and increased risk of getting SSHL. Comorbidity of diabetes in patients with CKD appeared to be associated with increased risk of getting SSHL, especially for the patients who are 35 years of age and older. Laryngoscope, 2013

Hesperetin, a selective phosphodiesterase (PDE)4 inhibitor, is present in the traditional Chinese medicine, “Chen Pi.” Therefore, we were interested in investigating its effects on ovalbumin- (OVA-) induced airway hyperresponsiveness, and clarifying its rationale for ameliorating asthma and chronic obstructive pulmonary disease (COPD). Hesperetin was revealed to have a therapeutic (PDE4H/PDE4L) ratio of >11. Hesperetin (10 ~ 30 μmol/kg, intraperitoneally (i.p.)) dose-dependently and significantly attenuated the airway hyperresponsiveness induced by methacholine. It also significantly suppressed the increases in total inflammatory cells, macrophages, lymphocytes, neutrophils, and eosinophils, and levels of cytokines, including interleukin (IL)-2, IL-4, IL-5, interferon-γ, and tumor necrosis factor-α in bronchoalveolar lavage fluid (BALF). It dose-dependently and significantly suppressed total and OVA-specific immunoglobulin E levels in the BALF and serum. However, hesperetin did not influence xylazine/ketamine-induced anesthesia, suggesting that hesperetin has few or no emetic effects. In conclusion, the rationales for ameliorating allergic asthma and COPD by hesperetin are anti-inflammation, immunoregulation, and bronchodilation.

The Ca(2+) channel subtypes in the neurotransmission of isolated guinea pig trachea were elucidated by monitoring the effects of specific Ca(2+) channel blockers on cholinergic contractions and nonadrenergic noncholinergic (NANC) relaxation elicited by electrical field stimulation (EFS). In isolated guinea pig trachea, cholinergic contractile responses to low- and high-frequency EFS were inhibited by the selective N-type calcium channel blocker, ω-conotoxin MVIIA. ω-Agatoxin IVA (a selective P-type blocker), ω-conotoxin MVIIC (a nonselective N-, Q-, and P-type blocker), and nifedipine (a selective L-type blocker) were ineffective, whereas Ni(2+) (a T- and R-type blocker) facilitated cholinergic contractions and produced a late contracture when its concentration exceeded 30 μM. The more the concentration of Ni(2+) increased, the greater the number of incidences and the late contracture areas which occurred. Late contracture did not seem to be due to the effects of acetylcholine, tachykinins, or other polypeptides, but disappeared in the absence of indomethacin. The NANC relaxant responses elicited by the low- and high-frequency EFS were inhibited by ω-conotoxin MVIIA or Ni(2+), but unaffected by ω-Agatoxin IVA, ω-conotoxin MVIIC, and nifedipine. In the absence of indomethacin, Ni(2+) did not alter the ω-conotoxin MVIIA (100 nM)-resistant component of cholinergic contraction, but significantly further inhibited that of NANC relaxation. These results suggest that in isolated guinea pig trachea, cholinergic contraction is regulated by N-type calcium channels which may mask T- and R-type calcium channels and may be co-modulated by both, while NANC relaxation is mainly and independently controlled by N-, T-, and R-type calcium channels.

INTRODUCTION The primary goals of management for congenital or acquired laryngeal webs are twofold: to establish a patent airway and to achieve a good voice quality. In a review of current otolaryngology literature, surgical treatments could be classified into four categories: 1) intralaryngeal resection of web and repeat lysis of adhesions; 2) laryngofissure, resection of laryngeal web, and placement of a keel; 3) intralaryngeal resection of web and placement of a plate; and 4) intralaryngeal mucosal flap. Among these methods, the second category, proposed by McNaught in 1950, is recognized as the treatment of choice for laryngeal webs. However, the need for two separate external approaches and a tracheotomy rendered this method less desirable. Therefore the third method, using an intralaryngeal approach, is favored and is still under modification and improvisation. The advantages for this method are multiple. First, it does not require an external wound. Second, it allows the patient to maintain normal speech and deglutition function after surgery. In this report, we combined the intralaryngeal approach and the concept of lateralization proposed by Kirchner and designed a simple surgical method for the management of laryngeal webs.

The research studies the relation of the learner's knowledge searching depth to his/her creativity when learner comes into contact with constructed knowledge. The digitized constructed knowledge environment has changed the way that knowledge has been presented through the books. By using information technology, learners now obtain knowledge rapidly in a computer-learning environment. When a learner facing a project, the way he/she searches information to build up his/her knowledge becomes a subject which is well worthy a discussion. This research first recorded each student viewing the mission-related instructional materials on computer pages in limited time. Followed by analyzing the route of subject's cognitive processes to study the relation of students who with different creativity performances to their knowledge searching depth. The participants are vocational high school students from the innovated project design class and their projects in this experiment are creative poster design. Researchers recorded and analyzed participants' viewing routes among supplied poster-design instructional materials. Researchers expect to find out the relation by discussing the knowledge-searching process between different creativity performers.

The demographics of parotid neoplasms in different populations have been reported by various centres. In this investigation, we reviewed retrospectively all the in-patient and out-patient charts and records of 108 patients who were diagnosed with parotid neoplasms and received parotidectomies in our department from 1 January 1993 to 15 April 2000. Patient age, gender, tumour pathology, fine-needle aspiration cytology results, and the intraparotid anatomy of the facial nerve were noted. We showed that despite the difference between our Taiwanese and previously studied patient populations, both populations had a similar distribution, diagnosis and treatment of parotid neoplasms, although the incidence of parotid tuberculosis was higher in our patient group. In addition, the facial nerve anatomy within the parotid gland had three main branching patterns in the upper and lower division.

Awoman inher50swasadmitted toourhospitalwitha5-weekhistoryofanontendermassontherightsideof theneck.Nohuskyvoice, dysphagia,orodynophagiawerereported.Aphysicalexaminationrevealed a2 × 2-cm tumorover the right sideof her neck at level III. Bilateral vocal fold movements were normal. The free thyroxine level was0.94ng/dL, and the thyroid-stimulatinghormone levelwas 1.33 mIU/mL. (To convert thyroxine to picomoles per liter, multiply by 12.871.) Fine-needle aspiration (FNA) was performed, and cellular changes suspected to bemalignant neoplasmwere reported. Computed tomographic images of the neck showed enlargement of the right side of the thyroid glandwith retrosternal extension, and total thyroidectomywas arranged (Figure, A, arrowhead). During the operation, the tumorwas found to extend to the thoracic cavity and to be attached tightly to the right carotid artery. The surgical specimen showed a 6.5 × 6.0 × 2.8-cmdark brown and elasticmass replacing mostof therightsideofthethyroid.Thetumorpossessedaroughsurface, and focal hemorrhages were also noted. The thyroid tumor appeared to be composed of broad anastomosing islands of tumor cells separated by desmoplastic stroma (Figure, B). No lymphovascular invasion or extrathyroidal extensions were identified. The tumor cell nests were well demarcated, with smooth borders in some areas, and a syncytial pattern could also be observed with irregular borders in other areas.Microscopically, the tumorwas composed of confluentnestsandlobulesofepithelioidandspindle-shapedcellssurroundedbyfibroussepta.Thetumorcellshadvesicularnucleiandeosinophiliccytoplasm.Markedanisonucleosiswithirregularnuclearcontourswerealsonoted.Thenuclear-cytoplasmic ratioswereveryhigh, andthepleomorphictumorcellnucleialongwithasmallnucleoliwere evident. Increased lymphocyteandplasmacell infiltrationaroundand within the tumor cell nests was seen. Immunohistochemical studies revealedthat thetumorcellswerepositive forcytokeratin (Figure,C), CD5 (Figure, D), andp63butwere negative for thyroid transcription factor-1. What is your diagnosis? A B

BackgroundHesperetin was reported to selectively inhibit phosphodiesterase 4 (PDE4). While hesperetin-7,3'-O-dimethylether (HDME) is a synthetic liposoluble hesperetin. Therefore, we were interested in investigating its selectivity on PDE4 and binding ability on high-affinity rolipram-binding sites (HARBs)in vitro, and its effects on ovalbumin-induced airway hyperresponsivenessin vivo, and clarifying its potential for treating asthma and chronic obstructive pulmonary disease (COPD).MethodsPDE1~5 activities were measured using a two-step procedure. The binding of HDME on high-affinity rolipram-binding sites was determined by replacing 2 nM [3H]-rolipram. AHR was assessed using the FlexiVent system and barometric plethysmography. Inflammatory cells were counted using a hemocytometer. Cytokines were determined using mouse T helper (Th)1/Th2 cytokine CBA kits, and total immunoglobulin (Ig)E or IgG2alevels were done using ELISA method. Xylazine (10 mg/kg)/ketamine (70 mg/kg)-induced anesthesia was performed.ResultsHDME revealed selective phosphodiesterase 4 (PDE4) inhibition with a therapeutic (PDE4H/PDE4L) ratio of 35.5in vitro.In vivo, HDME (3~30 μmol/kg, orally (p.o.)) dose-dependently and significantly attenuated the airway resistance (RL) and increased lung dynamic compliance (Cdyn), and decreased enhanced pause (Penh) values induced by methacholine in sensitized and challenged mice. It also significantly suppressed the increases in the numbers of total inflammatory cells, macrophages, lymphocytes, neutrophils, and eosinophils, and levels of cytokines, including interleukin (IL)-2, IL-4, IL-5, interferon-γ, and tumor necrosis factor-α in bronchoalveolar lavage fluid (BALF) of these mice. In addition, HDME (3~30 μmol/kg, p.o.) dose-dependently and significantly suppressed total and ovalbumin-specific immunoglobulin (Ig)E levels in the BALF and serum, and enhanced IgG2alevel in the serum of these mice.ConclusionsHDME exerted anti-inflammatory effects, including suppression of AHR, and reduced expressions of inflammatory cells and cytokines in this murine model, which appears to be suitable for studying the effects of drugs on atypical asthma and COPD, and for screening those on typical asthma. However, HDME did not influnce xylazine/ketamine-induced anesthesia. Thus HDME may have the potential for use in treating typical and atypical asthma, and COPD.