Aflatoxin B_1 투여가 急性 肝 病變에 미치는 영향에 對한 病理學的 硏究

장선문,이충식,강대영 충남대학교 의과대학 지역사회의학연구소 1989 충남의대잡지 Vol.16 No.1

In an attempt of elucidate the pathologic and histochemical changes of aflatoxin B_2-induced hepatie lesions, the present study in male Sprague-Dawley rats was undertaken to evalute the relation between pathologic change of the liver and histochemical changes of several enzymes : alkaline phosphatase, acid phosphatase and succinic dehydrogenase at 3. 9. 24. 48. 72, and 144 hours after single administration of aflatoxin B_1 by gastric tube. The aflatoxin B_1 was dissolved in peanut oil(0.5㎎ aflatoxin B_1 to 0.5ml peanut oil). Grouop of male rats received aflatoxin B_1 1㎎ per ㎏ of body weight, respectively. Control animals were given a similar volume of peanut oil alone. The results on morphologic and histochemical changes were as follows: 1. The necrotic change of liver was mainly periportal, and it became most severe at 24 hours and was more prominent in the large dose group than the small dose group. 2. Biliary ductular cell proliferation started to appear within 72 hours and after became regressed later in the small dose group, but it remained approximately 144 hours after exposure in the large dose group. 3. Electron microscopically, all three groups showed irregular nuclear membrane and nucleolar change characterized by segregation of granular and fibrillar elements. All the group showed cytoplasmie changes such as dilatation of rough endoplasmic reticulum with detached ribosome, hyperplasia of smooth endoplasmic reticulum, increased numbers of lipid droplets and mitochondrial alteration. The above change in the large dose group was more severe than those of the small dose group. 4. In the histochemical study of experimental animals, there was a decrease in the intensity of the staining reaction of alkaline phosphatase and succinic dehydrogenase within 24 hours and a progressive decrease in staining intensity was noted at 144 hours. And then the staining intensity of the acid phosphatase was similar to that shown by the control animal. In summary, the data obtained by present experiments indicate aflatoxin B_1 exerts periportal necrosis of hepatic lobules accompanied by bile ductular cell proliferation, and inhibition of protein synthesis, as jedged by elertron microscopic and histochemical changes.

Long second toe: its nail and skin changes

( Geun-hwi Park ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Nail can be affected by trauma, infection, and systematic disorders. In particular, the toe nails are exposed to the repeated and cumulative minor traumas, which usually result in thickened, splitted, and discolorated nails. Considering these, it can be inferred that the long second toe can be related to various nail and skin changes by repeated minor traumas such as friction in shoes, but the study or report on this topic hasn’t been done yet. Objectives: The purpose of this study was to introduce various nail and skin changes on long second toe. Methods: We analyzed the kinds of nail/skin changes of 50 patients with long second toe, enrolled at Pusan National University Hospitals (Busan and Yangsan) from 2013 to 2018. Results: There was no significant difference in the incidence of left and right toe and toenail, and 7 (14%) patients presented bilateral distribution. The most common nail change on long second toe was melanonychia (23, 46%), followed by subungual hematoma (15, 30%), onycholysis (2, 4%), subungual hyperkeratosis (2, 4%), onychomadesis (1, 2%), and retronychia (1, 2%). The most common skin change was corn (9, 18%), followed by paronychia (2, 4%). Twenty (20/50, 40%) patients also had other toe or toenail changes. Among them, the most common site was big toe/nail (13, 62%), and the most common change was subungual hematoma (8, 42%). Conclusion: Through this study, the dermatologists can recognize and diagnose the nail and skin changes of long second toe.

북서태평양에 서식하는 살오징어(Todarodes pacificus) 계군 분석에 대한 고찰

김정연,문창호,윤문근,강창근,김경렬,나태희,최은정,이충일,Kim, Jeong-Yun,Moon, Chang-Ho,Yoon, Moon-Geun,Kang, Chang-Keun,Kim, Kyung-Ryul,Na, Taehee,Choy, Eun Jung,Lee, Chung Il 한국해양학회 2012 바다 Vol.17 No.4

This paper reviews comparison analysis of current and latest application for stock identification methods of Todarodes pacificus, and the pros and cons of each method and consideration of how to compensate for each other. Todarodes pacificus which migrates wide areas in western North Pacific is important fishery resource ecologically and commercially. Todarodes pacificus is also considered as 'biological indicator' of ocean environmental changes. And changes in its short and long term catch and distribution area occur along with environmental changes. For example, while the catch of pollack, a cold water fish, has dramatically decreased until today after the climate regime shift in 1987/1988, the catch of Todarodes pacificus has been dramatically increased. Regarding the decrease in pollack catch, overfishing and climate changes were considered as the main causes, but there has been no definite reason until today. One of the reasons why there is no definite answer is related with no proper analysis about ecological and environmental aspects based on stock identification. Subpopulation is a group sharing the same gene pool through sexual reproduction process within limited boundaries having similar ecological characteristics. Each individual with same stock might be affected by different environment in temporal and spatial during the process of spawning, recruitment and then reproduction. Thereby, accurate stock analysis about the species can play an efficient alternative to comply with effective resource management and rapid changes. Four main stock analysis were applied to Todarodes pacificus: Morphologic Method, Ecological Method, Tagging Method, Genetic Method. Ecological method is studies for analysis of differences in spawning grounds by analysing the individual ecological change, distribution, migration status, parasitic state of parasite, kinds of parasite and parasite infection rate etc. Currently the method has been studying lively can identify the group in the similar environment. However It is difficult to know to identify the same genetic group in each other. Tagging Method is direct method. It can analyse cohort's migration, distribution and location of spawning, but it is very difficult to recapture tagged squids and hard to tag juveniles. Genetic method, which is for useful fishery resource stock analysis has provided the basic information regarding resource management study. Genetic method for stock analysis is determined according to markers' sensitivity and need to select high multiform of genetic markers. For stock identification, isozyme multiform has been used for genetic markers. Recently there is increase in use of makers with high range variability among DNA sequencing like mitochondria, microsatellite. Even the current morphologic method, tagging method and ecological method played important rolls through finding Todarodes pacificus' life cycle, migration route and changes in spawning grounds, it is still difficult to analyze the stock of Todarodes pacificus as those are distributed in difference seas. Lately, by taking advantages of each stock analysis method, more complicated method is being applied. If based on such analysis and genetic method for improvement are played, there will be much advance in management system for the resource fluctuation of Todarodes pacificus. 본 종설논문은 살오징어의 기존 및 최근에 새롭게 적용되고 있는 계군 분석방법들을 비교 분석하여 각 분석방법의 장단점과 분석방법간의 상호보완에 대하여 고찰하였다. 살오징어는 북서태평양의 넓은 지역을 회유하는 어종으로 생태계 및 상업적으로 중요한 자원이다. 살오징어는 해양환경변화의 생물학적 지표로서의 가능성을 평가 받고 있으며, 장단기적인 어획량 및 분포역의 변화가 환경 변화와 함께 나타난다. 예를 들어, 1987/1988 무렵에 발생한 기후체제전환 이후 한류성 어종으로 분류되는 명태의 어획량은 급감하여 현재까지 그 영향이 지속되고 있는 반면, 살 오징어 어획량은 크게 증가하였다. 현재까지 명태 어획량의 감소에 대하여 남획과 기후변화에 초점이 맞추어진 해석이 있으나, 뚜렷한 원인 분석은 이루어지지 않고 있다. 그 이유 중 한 가지는 계군 분석에 근거한 생태, 환경적 측면에 대한 정확한 원인 분석이 이루어지지 않고 있는 것과 관련이 된다. 계군은 유사한 생물학적 특징을 가진 개체들이 제한된 영역 내에서 유성생식과정을 통하여 동일한 유전자 풀(gene pool)을 공유하는 집단으로, 동일 계군을 형성하는 개체들은 산란에서 자원으로 가입 후 다시 재생산 과정에 이르기까지 시간 및 공간적으로 각기 다른 환경의 영향을 받을 수 있다. 따라서, 종에 대한 정확한 계군 분석은 자원의 효과적인 관리 및 급격한 변화에 대한 중요한 대응 방안의 역할을 할 수 있다. 살오징어 계군 분석에 적용된 주요 방법은 크게 4가지로 형태학적 방법, 생태학적 방법, 표지방류법, 유전학적 방법이 있다. 형태학적인 방법은 분석방법이 가장 간단하고 다수의 개체를 비교적 쉽게 분석할 수 있지만 각 형질들은 성장기간 동안 환경에 의해 영향을 많이 받게 되어 개체간의 차이가 생긴다. 생태학적 방법은 주로 개체의 생리적인 변화와 분포 및 회유상태, 기생충의 기생상태나 종류 및 기생률 등을 분석, 산란장의 차이를 알아보는 연구이며, 현재 활발히 연구되고 있는 방법으로 유사한 환경에서 생활하는 집단을 알 수 있지만 유전적으로 같은 집단인지는 알기 어렵다. 표지방류법은 직접적인 방법으로 계군의 회유 및 분포, 산란장의 위치를 파악할 수 있지만 수거가 어렵고 초기 단계에는 표식을 하기 어렵다. 수산생물의 계군 분석을 위한 유전학적 방법은 자원관리학적 연구에 관한 기본적 정보를 제공해 왔다. 계군 분석을 위한 유전학적 방법은 이에 사용하는 유전자 마커(marker)의 감도에 따라 결정되며, 유전자 마커의 다형성이 높은 것을 선택해야 한다. 계군 분석을 위한 유전자 마커로는 오랜 기간 동안 동위효소 다형이 사용되어졌으며, 최근에는 mitochondria, microsatellite와 같이 DNA 염기배열 중에서도 변이성이 높은 영역을 선택하여 마커로 이용한 연구가 증가되고 있다. 기존의 형태학적 방법, 표지방류법, 생태학적인 방법들은 살오징어의 생활사, 회유경로, 산란장의 변화 등을 밝혀내어 계군을 파악하는데 많은 기여를 하였지만 여전히 각 해역에 분포하는 살오징어의 계군을 파악하기에는 어려움이 있다. 최근에는 기존의 계군 분석이 지닌 장단점을 비교 분석하여 복합적인 방법의 계군 분석이 이루어지며, 이러한 정보들을 바탕으로 유전학적 방법을 보완한다면 살오징어 자원의 변동에 대한 관리 방안을 마련하는데 도움을 줄 것이다.

Design of Digital Filter to minimize An Afterimage Phenomenon occurring in processing Image Signal

Moon, O Hak,Lee, Bong Geun,Lee, Ho Nam,Lee, Young Ho,Kang, Bong Soon,Hong, Chang Hee 동아대학교 정보기술연구소 2001 情報通信硏究所論文誌 Vol.8 No.2

In this paper, we propose a method, an optimized architecture of a device with an image signal process of a field unit to minimize the flick phenomenon that happens in direction of a color temperature at a color tone change. The proposed IIR loop filter has an optimized architecture and reduced hardware compared with previous filters. In order to achieve the optimization for the hardware complexity. It is designed by time-multiplexing architecture. The proposed IIR loop filter is synthesized by suing the STD90 0.35um cell library.

Graves 병 환자에서 항갑상선제 투여에 의한 TSH 수용체 항체의 변동에 관한 연구 : 치료 용량 및 기간에 따른 차이 및 임상상과의 관계 its relation to dose and duration of treatment~and clinical features

이문호,조보연,문대혁,고창순,민헌기,서교일 대한내과학회 1986 대한내과학회지 Vol.30 No.3

We undertook a prospective study of 59 patients with Graves' disease in order to clarify the influence of antithyroid drug on the immunological indices and to determine the association of the changes of TSH receptor antibodies activities with drug dosage, duration of treatment and clinical features according to mode of antitbyroid drugs treatment. Patients were divided into two groups. High dose group included 28 patients and conventional dose group 31 patients. We measured TBII activities, antimicrosomal antibodies, and the size of goiter every 3 months, comparing them with clinical features and laboratory findings. TBII activities declined from R months until 9 months following drug treatment. Therafter no significant change of TBII activities were observed. Antimicrosomal antibodies showed the same pattern of change. There was no statistically significant difference of declining rate of TBII activities, antimicrosomal antibodies, and reduction of size of thyroid between two treatment groups. TBII activities fell into normal range in 15 patients among those 44 patients who had been followed for more than 9 months (8 high dose group, 7 conventional dose group). In those 15 patients, TBII activities and frequency of exophthalmos were less than those whose TBII activity did not normalized. We conclude that TSH receptor antibodies activities and antithyroid autoantibodies are diminished by antithyroid drug treatment in patients with Graves disease and there is no relationship between dose of drug and declining of TBII activities. We suggest that changing levels of TBII activities might be secondary phenomenon which can be achieved by control of thyroid function by antithyroid drug rather than direct immunosuppressive effect of antithyroid drug per se.

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

개에서 동소성 간이식술시의 대사 및 혈역학적 변화

이창준,홍순용,신근만,최영룡,이영주,문종선 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.3

Skilled and experienced anestheia is of great importance for patients undergoing orthotopic liver transplantation, because of multiple preexisting medical problems in such patients as well as the intraoperative problems of rapid hemodynamic, metabolic, and coagulation changes. In this study, the intraoperative hemodynamic and laboratory data were analyzed in ten dogs that underwent an orthotopic liver transplantation procedure by veno-venous bypass using Biopump. Liver transplantation can be divided into three distinct periods: stage I, or preanhepatic stage, which begins with the induction of anesthesia and continues until cross clamping of portal vein and IVC; stage II, or anhepatic stage, which begins at the anhepatic time and continues until the donor liver is reperfused by the recipients circulating blood; and stage III, or postanhepatic stage, which begins at the time of reperfusion and continues until the end of surgical procedure. The hemodynamic changes at the time of IVC and portal vein cross clamping were decreases in CVP, PCWP, and pulmonary artery pressure in spite of using Biopump. The significant metabolic alternations during anhepatic stage were decrease in blood glucose levels and increase in blood lactate levels. The more significant hemodynamic changes occurred at the time of reperfusion. Systolic pressure decreased suddenly to 58±6 mmHg and cardiac output decreased to 1.08±0.1l L/min. However heart rate, pulmonary artery pressure, CVP, and PCWP did not change significantly. During stage III, hyperglycemia occurred quite frequently. Significant abnormal coagulation chages could not be found, probably because the dogs were healthy. In conclusion, during anhepatic stage, we have to compensate for alternations of fluid balance. At the time of reperfusion, we should prevent severe hemodynamic changes and treat them immediately if they occur. However, it seems that glucose administration is not necessary to the liver recipient during stage II because there is no significant hemodynamic depression e to hypoglycemia at this time and hyperglycemia occurs later

LY6D is crucial for lipid accumulation and inflammation in nonalcoholic fatty liver disease

Lee Jibeom,Kim Hyeonhui,Kang Yun-Won,Kim Yumin,Park Moon-young,Song Ji-Hong,Jo Yunju,Dao Tam,Ryu Dongryeol,Lee Junguee,Oh Chang-Myung,Park Sangkyu 생화학분자생물학회 2023 Experimental and molecular medicine Vol.55 No.-

Nonalcoholic fatty liver disease (NAFLD) is a serious metabolic disorder characterized by excess fat accumulation in the liver. Over the past decade, NAFLD prevalence and incidence have risen globally. There are currently no effective licensed drugs for its treatment. Thus, further study is required to identify new targets for NAFLD prevention and treatment. In this study, we fed C57BL6/J mice one of three diets, a standard chow diet, high-sucrose diet, or high-fat diet, and then characterized them. The mice fed a high-sucrose diet had more severely compacted macrovesicular and microvesicular lipid droplets than those in the other groups. Mouse liver transcriptome analysis identified lymphocyte antigen 6 family member D (Ly6d) as a key regulator of hepatic steatosis and the inflammatory response. Data from the Genotype-Tissue Expression project database showed that individuals with high liver Ly6d expression had more severe NAFLD histology than those with low liver Ly6d expression. In AML12 mouse hepatocytes, Ly6d overexpression increased lipid accumulation, while Ly6d knockdown decreased lipid accumulation. Inhibition of Ly6d ameliorated hepatic steatosis in a diet-induced NAFLD mouse model. Western blot analysis showed that Ly6d phosphorylated and activated ATP citrate lyase, which is a key enzyme in de novo lipogenesis. In addition, RNA- and ATAC-sequencing analyses revealed that Ly6d drives NAFLD progression by causing genetic and epigenetic changes. In conclusion, Ly6d is responsible for the regulation of lipid metabolism, and inhibiting Ly6d can prevent diet-induced steatosis in the liver. These findings highlight Ly6d as a novel therapeutic target for NAFLD.

A Comparison Between Stroke Patients Admitted to Oriental Hospital in the Years 1987 and 1994

Lee Kyung-sup,Cho, Ki-ho,Kim, Young-suk,Ko, Chang-nam,Moon Sang-kwan,Bae Hyung-sup INSTITUTE OF ORIENTAL MEDICINE KYUNG-HEE UNIVERSIT 1998 JOURNAL OF ORIENTAL MEDICINE Vol.3 No.1

The characteristics of stroke slightly vary as time changes. To compare the characteristics of stroke between the 1980s and 1990s we investigated the clinical records of stroke patients in 1987 and 1994. The subjects of this study consisted of the 1971 patients who were admitted as stroke patients to the Kyunghee University Oriental Medicine Hospital during these two years. There were 1092 stroke patients admitted from May, 1987 to April, 1988 and 879 stroke patients admitted between May, 1994 and April, 1995. The results were as follows. The frequency of cerebral infarction was 77.9% in 1987 and 79.9% in 1994. The male to female ratio of stroke patients was 1.4:1 in 1987 and 1.6:1 in 1994. The occurrence rate of stroke in both 1987 and 1994 were highest in patients in their 60s, followed by those in their 50s, 70s and older, in their 40s, and finally their 30s and below. We especially found that the rate of patients in their 70s and over increased from 17.8% in 1987 to 25.3% in 1994, which was remarkable in cerebral infarction patients. The most common disease preceding a stroke was hypertension, followed by heart disease and diabetes in 1987, and in 1994 hypertension was the most common, followed by diabetes and heart disease. The rate of recurrence among cerebral hemorrhage, that was 12% in 1987 and 24.7% in 1994. The most frequent complications of stroke in 1987 and 1994 were pneumonia and urinary tract infection, respectively. The prescriptions used most frequently during admission were Chungpaesagan-tang followed by Sunghyangjungki-san, Yangyeksanhwa-tang etc. in both 1987 and 1994. When patients were getting better, prescriptions for invigorating Qi and enriching the blood(補氣血) were used more frequently. In conclusion, the most remarkable change of stroke patients from 1987 to 1994 was an increase in occupancy rate of aged patients, especially those in their 70s and older. So we suggest that more research are needed on the stroke of aged man, along with many other subjects on stroke.

Safety assessment of trans-tympanic photobiomodulation

Moon, T. H.,Lee, M. Y.,Jung, J. Y.,Ahn, J. C.,Chang, S. Y.,Chung, P. S.,Rhee, C. K.,Kim, Y. H.,Suh, M. W. Springer Science + Business Media 2016 Lasers in medical science Vol.31 No.2

<P>We evaluated functional and morphological changes after trans-tympanic laser application using several different powers of photobiomodulation (PBM). The left (L) ears of 17 rats were irradiated for 30 min daily over 14 days using a power density of 909.1 (group A, 5040 J), 1136.4 (group B, 6300 J), and 1363.6 (group C, 7560 J) mW/cm(2). The right (N) ears served as controls. The safety of PBM was determined by endoscopic findings, auditory brainstem response (ABR) thresholds, and histological images of hair cells using confocal microscopy, and light microscopic images of the external auditory canal (EAC) and tympanic membrane (TM). Endoscopic findings revealed severe inflammation in the TM of C group; no other group showed damage in the TM. No significant difference in ABR threshold was found in the PBM-treated groups (excluding the group with TM damage). Confocal microscopy showed no histological difference between the AL and AN, or BL and BN groups. However, light microscopy showed more prominent edema, inflammation, and vascular congestion in the TM of BL ears. This study found a dose-response relationship between laser power parameters and TM changes. These results will be useful for defining future allowance criteria for trans-tympanic laser therapies.</P>