Obstructive Sleep Apnea Is Associated With Late-Onset Preeclampsia in Overweight Pregnant Women in Korea

Ryu Gwanghui,김유민,Choi Suk-Joo,Hong Sang Duk,정용기,오수영,Kim Hyo Yeol,이경은 대한의학회 2023 Journal of Korean medical science Vol.38 No.2

Background: Obstructive sleep apnea (OSA) is closely related to maternal obesity in pregnant women, and the association increases with later pregnancy. Obesity and OSA are risk factors of pregnancy-related complications, including gestational hypertension, gestational diabetes mellitus (GDM), and fetal morbidities. We aimed to determine the prevalence of OSA and to assess the impact of OSA on pregnancy-related disorders in overweight pregnant women. Methods: Eligible participants who were overweight [body mass index (BMI) ≥ 23 kg/m2 ] in gestational age 30 weeks or more, assessed OSA using a portable polysomnography at home. Clinical data were collected from pregnant women and their babies. Results: The average age of 51 participants was 34.5 years (27–44 years). The number of primipara was 25 (49%) and that of multipara was 26 (51%). Eight cases of GDM (15.7%) and five cases of preeclampsia (9.8%) were reported, and six patients (11.8%) experienced preterm delivery. In results of polysomnography, 14 patients (27.5%) were diagnosed as OSA. Apnea-hypopnea index moderately correlated with BMI (r = 0.515, P < 0.001). The BMI (P < 0.005) and preeclampsia rate (P < 0.017) were higher in the OSA group compared to the control group. Odds ratios (ORs) adjusting age, BMI, parity, and abortion history were calculated. The presence of OSA increased OR of preeclampsia (OR, 13.1; 95% confidence interval, 1.1–171.3). The majority of preeclampsia patients (4/5, 80%) underwent preterm delivery. Conclusion: OSA is an important risk factor for preeclampsia, resulting in preterm delivery. For overweight pregnant women, an OSA evaluation should be mandatory.

Role of IL-17A in Chronic Rhinosinusitis With Nasal Polyp

Gwanghui Ryu,Jun-Sang Bae,Jihye Kim,Eun Hee Kim,Lele Lyu,Young-Jun Chung,모지훈 대한천식알레르기학회 2020 Allergy, Asthma & Immunology Research Vol.12 No.3

Purpose: Th17-associated inflammation is increased in chronic rhinosinusitis with nasal polyp (CRSwNP), and is associated with disease severity and steroid resistance. Overexpressed interleukin (IL)-17A affects CRSwNP by tissue remodeling, eosinophilic accumulation, and neutrophilic infiltration. We aimed to identify the role of IL-17A in CRSwNP and to evaluate the effects of anti-IL-17A blocking antibody on nasal polyp (NP) formation using a murine NP model. Moreover, we sought to investigate whether the inhibition of mechanistic target of the rapamycin (mTOR) signal pathway could suppress IL-17A expression and NP formation. Methods: Human sinonasal tissues from control subjects and patients with chronic rhinosinusitis (CRS) were analyzed using immunohistochemistry (IHC) and immunofluorescence staining. The effects of IL-17A neutralizing antibody and rapamycin were evaluated in a murine NP model. Mouse samples were analyzed using IHC, quantitative real-time polymerase chain reaction, and enzyme-linked immunosorbent assay. Results: IL-17A+ inflammatory cells were significantly increased in number in NP from patients with CRSwNP compared to that in uncinate process tissues from control subjects and patients with CRS without NP or CRSwNP. CD68+ M1 macrophages dominantly expressed IL-17A, followed by neutrophils and T helper cells, in NP tissues. Neutralization of IL-17A effectively reduced the number of NPs, inflammatory cytokines, and IL-17A-producing cells, including M1 macrophages. Inhibition of IL-17A via the mTOR pathway using rapamycin also attenuated NP formation and inflammation in the murine NP model. Conclusions: IL-17A possibly plays a role in the pathogenesis of CRSwNP, the major cellular source being M1 macrophage in NP tissues. Targeting IL-17A directly or indirectly may be an effective therapeutic strategy for CRSwNP.

Survey on Treatment-Seeking Patterns in Patients With Allergic Rhinitis

Ryu Gwanghui,Kim Do Hyun,Jeong Chang Yeong,Lee Sang Min,Lee Il Hwan,Kim Soo Whan,Yang Hyeon-Jong,Kim Mi-Ae,Kim Dong-Kyu 대한비과학회 2024 Journal of rhinology Vol.31 No.3

Background and Objectives: The medications preferred by patients for allergic rhinitis and their usage remain unclear. This study investigated treatment-seeking behaviors in patients with allergic rhinitis, including medical treatments, environmental controls, and surgical treatments.Methods: In this study, a cross-sectional survey was conducted by internal medicine, pediatric, or otorhinolaryngology physicians at university hospitals from January 2022 to April 2022. A questionnaire was administered to patients with confirmed allergic rhinitis to collect information regarding medical treatments (prescription and over-the-counter medication use patterns, comorbid asthma, and allergen-specific immunotherapy), environmental controls (usage of air purifiers and pet avoidance), and experiences with surgical treatments.Results: We included 51 patients with allergic rhinitis with a mean age of 31.6±16.0 years. Among them, 47 (92.2%) and 6 (11.8%) patients had pollen allergies and asthma, respectively. Furthermore, 41 (80.4%) patients took prescribed medicines, while 39 (76.5%) patients only used the medication when experiencing symptoms. Thirty patients (58.8%) reported concurrent use of intranasal sprays and oral medications. Thirty-three patients (64.7%) reported awareness of immunotherapy, and there were no preferential differences between subcutaneous (52%) and sublingual immunotherapy (48%). Of the 36 patients (70.6%) who reported using an air purifier, 38.9% considered it helpful in preventing allergic rhinitis symptoms. Fourteen patients (27.5%) currently or previously had a companion animal, with half experiencing worsening of symptoms. Twelve patients had received surgical treatment and reported high satisfaction levels (41.6%, very satisfied; 41.6%, satisfied).Conclusion: Patients with allergic rhinitis showed similar preferences for oral and spray medications. They also showed satisfaction with surgical treatments and an interest in the environmental management of allergic rhinitis.

편평세포상피암으로 오인한 비인두의 다형성 선종 2례

류광희(Gwanghui Ryu),홍상덕(Sang Duk Hong),정승규(Seung-Kyu Chung) 대한두개저학회 2018 대한두개저학회지 Vol.13 No.1

Pleomorphic adenoma (PA) of nasopharynx is very rare. Squamous metaplasia of PA is an unusual finding and has the possibility for misdiagnosis as squamous cell carcinoma (SCC). This study presents two cases of nasopharyngeal PA diagnosed as SCC from frozen sections, whereas permanent pathology was PA with squamous metaplasia. Preoperative endoscopy, radiographic images, and histopathological findings were reviewed. Two male patients underwent complete en-bloc resection of tumors with adequate margins because of the possibility of SCC from frozen section. The pathologic results were PA with squamous metaplasia and there was no recurrence during one year follow-up period. Nasopharyngeal PA can mimic SCC, surgeons should consider the clinical and radiological characteristics of tumors. We do not recommend deciding treatment modalities for nasopharyngeal tumors with only the frozen section.

대한천식알레르기학회 설하면역요법 진료지침

류광희 ( Gwanghui Ryu ),지혜미 ( Hye Mi Jee ),이화영 ( Hwa Young Lee ),강성윤 ( Sung-yoon Kang ),김경훈 ( Kyunghoon Kim ),김주희 ( Ju Hee Kim ),박경희 ( Kyung Hee Park ),박소영 ( So-young Park ),성명순 ( Myong Soon Sung ),이영수 ( 대한천식알레르기학회 2024 Allergy Asthma & Respiratory Disease Vol.12 No.3

Allergen immunotherapy (AIT) has been used for over a century and has been demonstrated to be effective in treating patients with various allergic diseases. AIT allergens can be administered through various routes, including subcutaneous, sublingual, intralymphatic, oral, or epicutaneous routes. Sublingual immunotherapy (SLIT) has recently gained clinical interest, and it is considered an alternative treatment for allergic rhinitis (AR) and asthma. This review provides an overview of the current evidence-based studies that address the use of SLIT for treating AR, including (1) mechanisms of action, (2) appropriate patient selection for SLIT, (3) the current available SLIT products in Korea, and (4) updated information on its efficacy and safety. Finally, this guideline aims to provide the clinician with practical considerations for SLIT.

Clinical Characteristics of Pediatric Chronic Rhinosinusitis: A Nationwide Retrospective Multicenter Study

Kim Donghyeok,Ryu Gwanghui,Hong Sang Duk,Yoo Shin Hyuk,Mun Sue Jean,Lee Eun Jung,Heo Sung Jae,Jeong Jin Hyeok,Kim Dae Woo,Hyung-Ju Cho,Rha Min-Seok,Kim Yong Min,Lee Ki-Il,Mo Ji-Hun 대한비과학회 2025 Journal of rhinology Vol.32 No.1

Background and Objectives: Pediatric chronic rhinosinusitis (CRS) significantly affects children’s quality of life and learning abilities. This study aimed to evaluate the postoperative outcomes in pediatric patients who underwent functional endoscopic sinus surgery (FESS) for CRS.Methods: A retrospective review was conducted on pediatric patients who underwent FESS for CRS at 11 university hospitals. The inclusion criteria were patients under 20 years old with bilateral disease who were operated on between January 2005 and December 2021. The data collected included demographics, clinical history, blood tests, preoperative computed tomography, and preoperative and postoperative symptom control. The Kruskal-Wallis and Fisher exact tests were used to compare the quantitative and qualitative data, respectively.Results: In total, 213 patients were enrolled. The mean age was 13.4±3.0 years, and 145 (68.1%) were male. One hundred sixty-four patients (77.0%) had nasal polyps and 33 patients (15.5%) underwent revision FESS. The preoperative symptoms, in order of prevalence, included nasal obstruction (87.8%), rhinorrhea (71.8%), a sense of postnasal drip (58.2%), hyposmia (44.6%), cough (24.4%), and facial fullness (18.3%). These symptoms were significantly alleviated for up to 3 years after surgery (p<0.001). At the time of the last follow-up, 121 patients (56.8%) were controlled, 80 (37.6%) were partly controlled, and 12 (5.6%) were uncontrolled. Patients in the uncontrolled group had higher Lund-Mackay scores, longer follow-up durations, and more instances of revision surgery compared to those in the controlled and partly controlled groups. When age was categorized into three groups, those aged 16 years or older tended to have lower Lund-Mackay scores and better control.Conclusion: FESS significantly improves both the postoperative symptoms and the long-term quality of life in pediatric CRS patients. Better symptom control is associated with older age and a lower disease burden.

A Survey on Biologics for the Treatment of Chronic Rhinosinusitis With Nasal Polyps Among Members of the Korean Rhinologic Society

Cha Hyunkyung,Ryu Gwanghui,Yoo Shin Hyuk,Mo Ji-Hun 대한비과학회 2023 Journal of rhinology Vol.30 No.3

Background and Objectives: In 2021, biologics were approved for treating chronic rhinosinusitis with nasal polyps (CRSwNP) in Korea. However, CRS is a heterogeneous disease, and its characteristics are thought to differ between Western and Korean populations. This study aimed to evaluate the experiences of members of the Korean Rhinologic Society during the first year of biologic usage for the treatment of nasal polyps.Methods: An anonymous survey consisting of 15 items was conducted from November to December 2021. The survey included questions about participant demographics, use of biologics for treating CRSwNP, and expectations regarding the effectiveness of biologics for treating CRSwNP.Results: In total, 44 members participated in the survey. Approximately half of the respondents were in their 40s (50.0%) and had 5–9 years of clinical experience as otorhinolaryngologists (47.7%). The majority of participants held academic positions (95.4%). About half of them worked in Gyeonggi Province. The utilization of biologics did not differ significantly based on clinical experience (p=0.192). When asked about the factors considered for prescribing biologics, the most common reason was recurrence of polyps after surgery (87.2%). The most frequent reason for discontinuing biologics was cost (48.6%). When asked about the extent to which they expected that the availability of biologics for CRSwNP treatment would reduce endoscopic sinus surgery (ESS), 45.5% of members expected a reduction of approximately 10%–29%. In addition, 20.5% expected a reduction of 50% or more. However, 61.4% expected a reduction of less than 10% in primary ESS. In addition, most respondents (93.2%) agreed with the need for Korea-specific guidelines for biologic treatment.Conclusion: There are discrepancies between the current guidelines for biologic treatment of CRSwNP and the reality of the situation, highlighting the need for the development of Korea-specific guidelines.

접형동의 함기화 정지 2예 및 문헌고찰

고성철(Sungchul Ko),류광희(Gwanghui Ryu) 대한두개저학회 2023 대한두개저학회지 Vol.18 No.1

Arrested pneumatization of the sphenoid sinus is normal developmental variant. Radiological find-ing on computed tomography (CT) or magnetic resonance image (MRI) may be confused with bony lesions of paranasal sinuses or invasive tumors of the skull base. A 43-year-old woman visited our hospital with headache, and an MRI scan performed at other hospital showed abnormal findings in the right sphenoid sinus. When the additional CT images were evaluated, it was diagnosed as an arrested pneumatization of the sphenoid sinus. A 46-year-old woman visited the neurologist with diplopia and had a brain MRI. Due to abnormal findings in the left sphenoid sinus, the patient was transferred to the otorhinolaryngology department. The left sphenoid sinus lesion was confirmed as an arrested pneumatization on CT and MRI. Both patients decided to follow-up without any special treatment. Differential diagnoses for this developmental variant would reduce treatment cost and exploratory surgery.

Biologics for Chronic Rhinosinusitis With Nasal Polyps: Current Status and Clinical Considerations in Korea

Lee Ki-Il,Ryu Gwanghui,Yoo Shin Hyuk,조형주,Mo Ji-Hun,Kim Chang-Hoon 대한비과학회 2025 Journal of rhinology Vol.32 No.1

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a prevalent condition that significantly impacts quality of life and places a burden on healthcare systems. The advent of biologics targeting type 2 immune pathways offers new therapeutic options for severe and/or uncontrolled CRSwNP. Initially, biologic use was guided by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 and the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) guidelines, despite limited data on clinical indications, response measures, and treatment duration. Since then, numerous studies and the EPOS/EUFOREA 2023 update have refined these guidelines. The update defines clinical indications for biologics based on type 2 inflammation markers by lowering the blood eosinophil threshold from 250 to 150 cells/μL. The response to biologics is now more simply categorized into three levels based on reductions in nasal polyp size, improvements in quality of life, and enhancement of smell. Treatment evaluation is recommended at 6 months with annual follow-up. Longer administration intervals, such as every four weeks, have also proven effective in well-controlled patients. Although specific guidelines for discontinuation or switching biologics remain lacking, clinical judgment is essential in determining when treatment should be stopped or adjusted. Additionally, regulatory updates support the use of biologics for CRSwNP, and novel agents such as tezepelumab (an anti-thymic stromal lymphopoietin monoclonal antibody) continue to show promise. Finally, in Korea, biologics for CRSwNP are not covered by national health insurance, leading to extended dosing intervals due to high costs. Despite this limitation, studies have shown that adjusted dosing can maintain subjective quality of life. Recent studies by Korean authors have also explored practical considerations such as dosing intervals and comparisons to surgery. Further research is needed to optimize treatment strategies, particularly regarding cost-effectiveness and prospective studies tailored to the Korean healthcare system.

A Case of Bilateral Trigeminal Amyloidoma Diagnosed Through an Endoscopic Transsphenoidal Approach

Park Song I,Ryu Gwanghui 대한비과학회 2023 Journal of rhinology Vol.30 No.3

Amyloidosis is a systemic disease characterized by the accumulation of amyloid protein in multiple organs. Amyloidoma, in contrast, is an uncommon localized form of amyloidosis that presents as a single mass or tumor-like lesion. Primary amyloidoma in the central nervous system is rare, and only a few cases have been reported. Notably, the Gasserian ganglion is the most frequently affected site of amyloidoma in the central nervous system, and progressive trigeminal neuropathy is a characteristic finding. Among these cases, the bilateral occurrence of amyloidoma is exceedingly rare. In this report, we present the case of a 51-year-old woman diagnosed with bilateral trigeminal amyloidoma, confirmed by an endoscopic biopsy via the transsphenoidal approach.