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Corey KB, Turner JH, Chowdhury NI, Chandra RK, Li P, Wu P, Cahill KN. Utility of nasal mucus inflammatory profile as a biomarker of nasal polyp regrowth in aspirin-exacerbated respiratory disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1644-1645.e1. [PMID: 35398556 PMCID: PMC9469779 DOI: 10.1016/j.jaip.2022.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
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Wang CS, Guo CL, Liu Z. [The effect of endotypes on the prognosis of patients with chronic rhino sinusitis]. ZHONGHUA ER BI YAN HOU TOU JING WAI KE ZA ZHI = CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY 2022; 57:644-648. [PMID: 35610691 DOI: 10.3760/cma.j.cn115330-20210509-00262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Kato A, Schleimer RP, Bleier BS. Mechanisms and pathogenesis of chronic rhino sinusitis. J Allergy Clin Immunol 2022; 149:1491-1503. [PMID: 35245537 PMCID: PMC9081253 DOI: 10.1016/j.jaci.2022.02.016] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/07/2022] [Accepted: 02/18/2022] [Indexed: 11/19/2022]
Abstract
Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by local inflammation of the upper airways and is historically divided into 2 main phenotypes: CRS with nasal polyps and CRS without nasal polyps. Inflammation in CRS is mainly characterized by 3 endotypes based on elevation of canonical lymphocyte cytokines: type (T) 1 (T1) by TH1 cytokine IFN-γ, T2 by TH2 cutokines IL-4, IL-5, and IL-13, and T3 by TH17 cytokines including IL-17. Inflammation in both CRS without nasal polyps and CRS with nasal polyps is highly heterogeneous, and the frequency of various endotypes varies geographically around the world. This finding complicates establishment of a unified understanding of the mechanisms of pathogenesis in CRS. Sinonasal epithelium acts as a passive barrier, and epithelial barrier dysfunction is a common feature in CRS induced by endotype-specific cytokines directly and indirectly. The sinonasal epithelium also participates in both innate immunity via recognition by innate pattern-recognition receptors and promotes and regulates adaptive immunity via release of chemokines and innate cytokines including thymic stromal lymphopoietin. The purpose of this review was to discuss the contribution of the epithelium to CRS pathogenesis and to update the field regarding endotypic heterogeneity and various mechanisms for understanding pathogenesis in CRS.
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Mullur J, Steger CM, Gakpo D, Bensko JC, Maurer R, Laidlaw TM, Buchheit KM. Aspirin desensitization and biologics in aspirin-exacerbated respiratory disease: Efficacy, tolerability, and patient experience. Ann Allergy Asthma Immunol 2022; 128:575-582. [PMID: 35131410 PMCID: PMC9058196 DOI: 10.1016/j.anai.2022.01.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patterns of medication use and efficacy in aspirin-exacerbated respiratory disease (AERD) have not been well characterized, especially since the advent of respiratory biologics. Aspirin therapy after desensitization (ATAD) is efficacious for upper and lower respiratory symptoms for patients with AERD, though aspirin-related adverse effects can limit therapy. The optimal coordination of ATAD and respiratory biologics for the treatment of AERD remains unclear. OBJECTIVE We aimed to characterize patterns of medication use and treatment experience with biologics and ATAD in AERD. METHODS We surveyed 98 patients with AERD recruited from the Brigham and Women's Hospital AERD registry. Patients completed an online questionnaire describing their medication history and treatment experience. RESULTS A total of 52 (53.0%) patients reported a history of use of one or more respiratory biologics (omalizumab, mepolizumab, reslizumab, benralizumab, or dupilumab), and 84 (85.7%) reported undergoing aspirin desensitization. There were 24 patients (24.4%) who reported concurrent use of a biologic and ATAD. Compared with those taking ATAD alone, patients taking a biologic and ATAD concurrently were less likely to report that aspirin was effective for their AERD symptoms (odds ratio, 0.161 [95% confidence interval, 0.03-0.76]; P =.02). Whereas patients reported varying efficacy with biologics, dupilumab had the highest odds of patients reporting it worked "very well" (odds ratio, 17.58 [95% confidence interval, 5.68-54.35]; P < .001). CONCLUSION Biologics are emerging as a treatment option for AERD and are generally well tolerated. Biologic efficacy in AERD is variable by agent, though most patients taking dupilumab found it to be effective. Patients on a biologic in conjunction with ATAD may represent a more severe subset of AERD for which ATAD alone is insufficient.
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Gelardi M, Giancaspro R, Cassano M. Chronic rhino sinusitis with nasal polyps recurrence: Not only eosinophils and neutrophils. Am J Otolaryngol 2022; 43:103447. [PMID: 35428533 DOI: 10.1016/j.amjoto.2022.103447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/29/2022] [Indexed: 11/19/2022]
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Shao B, Hagan MJ, Sastry RA, Kritselis M, Donahue JE, Toms SA. An Instructive Case of Cerebral Mucormycosis. RHODE ISLAND MEDICAL JOURNAL (2013) 2022; 105:8-12. [PMID: 35211702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Mucormycosis can lead to fatal rhinocerebral infection. CASE A 53-year-old male with diabetes presented with altered mental status. He had been recently discharged from an admission for COVID-19 pneumonia treated with remdesivir and methylprednisolone. Imaging demonstrated a large left frontal mass with midline shift suspicious for a primary brain neoplasm. His neurologic exam rapidly declined and the patient was taken to the operating room for decompressive hemicraniectomy. Post-operatively, the patient remained comatose and failed to improve. Autopsy revealed a cerebral mucormycosis infection. DISCUSSION Despite concern for a primary brain neoplasm the patient was diagnosed postmortem with a mucormycosis infection. Other features supporting this diagnosis included nasal sinusitis on initial scans, his fulminant clinical decline, rapidly progressive imaging findings, and persistent hyperglycemia throughout his clinical course. CONCLUSION In an era of high steroid usage to treat COVID-19, mucormycosis infection must be considered in high-risk patients demonstrating disproportionate clinical decline.
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Liu Z, Zeng M. [Promoting the research of endotypes of Chinese patients with chronic rhino sinusitis and facilitating precision medicine]. ZHONGHUA ER BI YAN HOU TOU JING WAI KE ZA ZHI = CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY 2022; 57:99-105. [PMID: 35196754 DOI: 10.3760/cma.j.cn115330-20210830-00581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Ramos CL, Woessner KM. Updates on treatment options in aspirin exacerbated respiratory disease. Curr Opin Allergy Clin Immunol 2022; 22:49-54. [PMID: 34939970 DOI: 10.1097/aci.0000000000000796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW The aim is to describe why this review is timely and relevant. Acetylsalicylic acid exacerbated respiratory disease (AERD) is a clinically significant disease affecting approximately 7% of all asthmatics or around 1,400,000 persons in the United States alone. A large portion of these patients remain undiagnosed. This review summarizes up to date knowledge on the pathophysiology, treatment opinions and provides an expert opinion on how to approach the AERD patient. RECENT FINDINGS Findings describe the main themes in the literature covered by the article. Review of the current knowledge in terms of the key cells, cytokines/chemokines contributing to the acquired disease state of AERD. It also provides clinical approach toward the AERD patient with regards to current treatment options. SUMMARY Summary describes the implications of the findings for clinical practice or research. This is an up-to-date review of the current literature, with insight into how to approach the management of an AERD patient.
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王 晓, 孟 一, 王 成, 张 罗. [The investigation of the histological differences between the mucosa on the nasal and sinus sides of uncinate process of chronic rhino sinusitis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:95-100. [PMID: 35172544 PMCID: PMC10128300 DOI: 10.13201/j.issn.2096-7993.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Indexed: 06/14/2023]
Abstract
Objective:The aim of this study is to check whether histopathological differences exist between the nasal side and the sinus side of uncinate process of chronic rhinosinusitis and the histopathological basis of nasal polyp was discussed. Methods:The uncinate processes of chronic rhinosinusitis and control subjects were enrolled from October 2016 to April 2017. The following histopathological data were assessed: height of basement membrane, the proportion of glands in the sub-epithelium, the numbers of goblet cells and inflammatory cells. Results:A total of 116 patients were recruited, including 38 chronic rhinosinusitis with nasal polyps(CRSwNP), 58 chronic rhinosinusitis without nasal polyps(CRSsNP) and 20 controls. There was no significant difference between age and gender distribution(P>0.05). The basement membrane was significantly thinner on the sinus side of the 3 groups' uncinate processes than on the nasal side except CRSwNP group(P<0.05). The basement membrane of CRSwNP and CRSsNP was significantly higher than control uncinate processes(P<0.05). Inflammatory cells number were significantly increased in CRSwNP and CRSsNP than in the control uncinate processes, and the nasal side was obviously more than the sinus side in the CRSwNP and CRSsNP groups(P<0.05). The number of goblet cells was more on the sinus side of the 3 groups uncinate processes than on the nasal side, that of CRSsNP and control were significant difference between the nasal side and sinus side(P<0.05). The proportion of glands was larger on the sinus and nasal side of the uncinate processes in CRSwNP and CRSsNP than that of the control uncinate processes(P<0.05), and the proportion of glands was significantly greater on the nasal side than on the sinus side of the uncinate processes in CRSwNP(P<0.05). Conclusion:Histopathological differences exist between the nasal side and sinus side of the ups of CRSwNP, CRSsNP and control. The nasal side is more prone to polyps than the sinus side, which may be related to the thickening of basement membrane, the increase of inflammatory cells and gland area, and the decrease of goblet cells.
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Lei C, Wang R, Yang D, Guo T, Luo H. Clinical phenotypes of primary ciliary dyskinesia. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:116-122. [PMID: 35545371 PMCID: PMC10930489 DOI: 10.11817/j.issn.1672-7347.2022.210379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Indexed: 06/15/2023]
Abstract
Primary ciliary dyskinesia (PCD) is a hereditary disease characterized by airway mucociliary clearance dysfunction. The estimated prevalence of PCD is 1꞉10 000 to 1꞉20 000. The main respiratory manifestations in children are cough, expectoration, chronic rhinitis, sinusitis, and chronic otitis media, while the most common symptoms in adults are chronic sinusitis, bronchiectasis, and infertility. About 50% of patients with certain PCD-related gene variants are combined with situs inversus, and the incidence of congenital heart disease is also high. The pathogenesis behind PCD is that gene variants cause structural or functional disorders of respiratory cilia and motile cilia of other organs, leading to a series of heterogeneous clinical manifestations, which makes it difficult to identify and diagnose PCD. Combining different disease screening tools and understanding the relationship between genotypes and phenotypes may facilitate early diagnosis and treatment for PCD.
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Han JB, Wang WQ, Zhu ZZ, Wang L, Wang XW, Zha Y, Lyu W. [Research progress of nasal mucosal epithelial cells in chronic rhino sinusitis]. ZHONGHUA ER BI YAN HOU TOU JING WAI KE ZA ZHI = CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY 2022; 57:78-81. [PMID: 35090218 DOI: 10.3760/cma.j.cn115330-20210303-00103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Ogasawara N, Kato A. [ROLE OF GROUP 2 INNATE LYMPHOID CELLS IN ALLERGIC INFLAMMATION OF THE UPPER RESPIRATORY TRACT]. ARERUGI = [ALLERGY] 2022; 71:195-199. [PMID: 35569940 DOI: 10.15036/arerugi.71.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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侯 军. [Diagnostic value of sinus CT score combined with serum allergen sIgE for postoperative recurrence in patients with eosinophilic CRSwNP]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:19-24. [PMID: 34979613 PMCID: PMC10128222 DOI: 10.13201/j.issn.2096-7993.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Indexed: 04/30/2023]
Abstract
Objective:To explore the combination of sinus CT score and serum allergen sIgE to construct a postoperative recurrence risk model for patients with eosinophilic CRSwNP. Methods:The clinical data of 183 patients with eosinophilic CRSwNP who were treated in Luohe Central Hospital from January 2016 to January 2019 were collected. The curative effect was evaluated one year after the operation. According to the postoperative recurrence, they were divided into recurrence group and non-recurrence group. Single factor analysis of clinical and pathological factors on the postoperative curative effect of patients, XGboost model and multivariate Cox analysis of factors affecting postoperative recurrence. Draw the receiver operating characteristic(ROC) curves of the two models to compare the prediction effects of the XGboost model. The Kaplan-Meier method draws survival curve and compares the recurrence-free survival rate of patients with different risk levels. Results:The results of Cox multivariate analysis showed postoperative adherence to comprehensive treatment, tissue EOS ratio, tissue NEU ratio, tissue lymphocyte ratio, tissue plasma cell ratio, peripheral blood NEU ratio, Allergen sIgE and total sinus CT score were independent risk factors for recurrence. The top six factors influencing postoperative recurrence in the XGboost model were allergen sIgE, total sinus CT score, tissue EOS ratio, postoperative adherence to comprehensive treatment, tissue lymphocyte ratio, and tissue plasma cell ratio. The ROC curve showed that the area under the ROC curve of the XGboost model was 0.818. Cox analysis (0.789) with more factors increased by 3.68%, and the sensitivity, specificity and Youden index of the model were significantly higher than the multivariate Cox analysis model. The factors included in the XGboost model were used to construct a postoperative recurrence risk model. The recurrence-free survival rate of high-risk group was significantly lower than that of low-risk group and intermediate-risk group (log-rank test value:21.946, P<0.001). Conclusion:The postoperative recurrence risk model established by the sinus CT score combined with serum allergen sIgE can effectively predict the incidence of postoperative recurrence in patients. The XGboost model is better than the multivariate Cox analysis model in predicting postoperative recurrence in patients with eosinophilic CRSwNP. It can be used to predict postoperative recurrence.
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Cazzador D, Padoan R, Colangeli R, Pendolino AL, Felicetti M, Zanoletti E, Emanuelli E, Martini A, Doria A, Nicolai P, Schiavon F. Health-Related Quality of Life in Patients With ANCA-Associated Vasculitis and Sinonasal Involvement: A Single-Center Cross-Sectional Study. J Clin Rheumatol 2022; 28:e89-e94. [PMID: 33136696 PMCID: PMC10836782 DOI: 10.1097/rhu.0000000000001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to assess the impact of sinonasal morbidity on quality of life (QoL) in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS This cross-sectional case-control study enrolled 71 patients-44 AAV cases with (ear, nose, and throat [ENT]-AAV) or without ENT involvement (non-ENT-AAV) undergoing multidisciplinary evaluations and 27 chronic rhinosinusitis (CRS) cases. Three validated QoL questionnaires (Sino-Nasal Outcomes Test-22 [SNOT-22], Nasal Obstruction Symptom Evaluation [NOSE], and Short-Form 36) were administered, and the 3 groups were compared. RESULTS The ENT-AAV patients were significantly younger (p = 0.01), with less antineutrophil cytoplasmic antibody positivity frequency (p = 0.035) and lower renal involvement (p = 0.003) than the non-ENT-AAV patients.The SNOT-22 questionnaire demonstrated significantly greater sinonasal morbidity in ENT-AAV patients compared with CRS patients (p < 0.001). The NOSE score of ENT-AAV patients was comparable to those of CRS patients, but higher than that of non-ENT-AAV patients (p < 0.001). The SNOT-22 and NOSE scores positively correlated with disease activity (p = 0.037; p = 0.004, respectively). Short-Form 36 domain-by-domain analysis revealed a significantly poorer QoL in ENT-AAV patients, especially with physical functioning being progressively impaired in CRS, non-ENT-AAV, and ENT-AAV patients (p < 0.001). No significant differences in QoL came to light when AAV patients were stratified according to current systemic o local treatments. CONCLUSIONS The QoL in AAV patients is significantly reduced, especially in the presence of ENT involvement. The AAV-related nasal morbidity is consistent and comparable to that reported by CRS patients. It significantly affects patients' QoL and in particular social functioning, leading to limitation in daily/work activities. Organ-focused questionnaires and multidisciplinary management are warranted to pursue a treat-to-target approach in these patients.
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Takabayashi T, Yoshida K, Imoto Y, Schleimer RP, Fujieda S. Regulation of the Expression of SARS-CoV-2 Receptor Angiotensin-Converting Enzyme 2 in Nasal Mucosa. Am J Rhinol Allergy 2022; 36:115-122. [PMID: 34232770 PMCID: PMC11066611 DOI: 10.1177/19458924211027798] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has caused a global pandemic. Higher expression of the virus receptor angiotensin-converting enzyme 2 (ACE2) in the nasal mucosa may be associated with high transmissibility and asymptomatic infection. In COVID-19, the elucidation of the determinants of ACE2 expression at nasal tissue level is crucial. The development of strategies to downregulate ACE2 expression in nasal epithelial cells might reduce transmission and be useful as a novel therapeutic approach. OBJECTIVE To verify ACE2 expression in the nasal mucosa of patients with seasonal allergic rhinitis induced by Japanese cedar pollen (SAR-JCP) and chronic rhinosinusitis with nasal polyp (CRSwNP) and to examine the effects of short-chain fatty acids (SCFAs) on ACE2 expression in airway epithelial cells. METHODS We assessed ACE2 expression in the nasal mucosa of control subjects, patients with SAR-JCP, and those with CRSwNP using real-time polymerase chain reaction. We also quantified ACE2 gene expression in cultured airway epithelial cells. RESULTS Although ACE2 expression was greatly increased in a few patients with SAR-JCP during the Japanese cedar pollen season, mean levels were not significantly increased. ACE2 mRNA expression was significantly decreased in nasal polyp tissue from patients with chronic rhinosinusitis compared with the expression in that from control subjects. SCFAs generated by gastrointestinal microbiota significantly reduced resting ACE2 expression in cultured airway epithelial cells. SCFAs also significantly suppressed the dsRNA-dependent upregulation of ACE2 expression in airway epithelial cells. CONCLUSION Inflammatory endotype affects ACE2 expression in the nasal mucosa and influences susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In particular, type 2 inflammation could downregulate ACE2 expression in the nasal mucosa and reduces susceptibility to SARS-CoV-2 in patients with CRSwNP. Although in vivo experiments are required, administration of SCFAs to the nasal cavity might be worthy of consideration as a preventative or therapeutic strategy for the early-stage COVID-19.
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Bachert C, Corren J, Lee SE, Zhang H, Harel S, Cunoosamy D, Khan AH, Jacob‐Nara JA, Siddiqui S, Nash S, Rowe PJ, Deniz Y. Association between dupilumab treatment effect on nasal polyp score and biomarkers of type 2 inflammation in patients with chronic rhino sinusitis with nasal polyps in the phase 3 SINUS-24 and SINUS-52 trials. Int Forum Allergy Rhinol 2021; 12:1191-1195. [PMID: 34970860 PMCID: PMC9544911 DOI: 10.1002/alr.22964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/07/2022]
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117
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Pan YW, Wu LJ, Zang HR. [Application of bioinformatics analysis in the study of chronic rhino sinusitis with nasal polyps]. ZHONGHUA ER BI YAN HOU TOU JING WAI KE ZA ZHI = CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY 2021; 56:1350-1353. [PMID: 34963227 DOI: 10.3760/cma.j.cn115330-20210406-00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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118
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Pulido LF, Murcia Salazar D, Gómez Amarillo D, Useche JN, Ghotme KA. Spontaneous thrombosis of a vein of Galen malformation associated with acute sinusitis: a case report. Childs Nerv Syst 2021; 37:3271-3276. [PMID: 33595709 DOI: 10.1007/s00381-021-05072-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
The vein of Galen malformation is caused by an abnormal shunting between choroidal arteries and the median prosencephalic vein during embryological development, leading to increased blood flow to the deep cerebral veins, intracranial damage, and systemic repercussions. Idiopathic spontaneous thrombosis of a vein of Galen malformation is rare, and its association with acute sinusitis has not been reported in the literature. We present the case of a girl with a postnatal diagnosis of a vein of Galen malformation at the age of 16 months, with secondary pulmonary hypertension that was adequately controlled with spironolactone. At 3 years old, while expecting elective endovascular treatment, the patient developed spontaneous thrombosis of the vein of Galen malformation, concomitant to an acute sinusitis episode, with complete resolution of the vascular malformation and secondary pulmonary hypertension. The patient continued with normal neurological development over a 5-year follow-up. We discuss the main pathophysiologic mechanisms that can explain spontaneous thrombosis of VOGMs and the patient's outcome. Awareness of different mechanisms that can lead to spontaneous thrombosis can help in the decision-making process and prompt targeted approaches to individual patients with a vein of Galen malformation.
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Park SC, Park IH, Lee JS, Park SM, Kang SH, Hong SM, Byun SH, Jung YG, Hong SJ. Microbiome of Unilateral Chronic Rhino sinusitis: A Controlled Paired Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189878. [PMID: 34574801 PMCID: PMC8469123 DOI: 10.3390/ijerph18189878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 01/21/2023]
Abstract
The sinonasal microbiota in human upper airway may play an important role in chronic rhinosinusitis (CRS). Thus, this study aimed to investigate the human upper airway microbiome in patients with unilateral CRS, and compare the sinonasal microbiome of the unilateral diseased site with that of a contralateral healthy site. Thirty samples, 15 each from the diseased and healthy sites, were collected from the middle meatus and/or anterior ethmoid region of 15 patients with unilateral CRS during endoscopic sinus surgery. DNA extraction and bacterial microbiome analysis via 16S rRNA gene sequencing were then performed. Corynebacterium showed the highest relative abundance, followed by Staphylococcus in samples from both the diseased and healthy sites. Further, the relative abundances of Staphylococcus and Pseudomonas were significantly lower in samples from diseased sites than in those from healthy sites. Conversely, anaerobes, including Fusobacterium, Bacteroides, and Propionibacterium, were abundantly present in samples from both sites, more so in samples from diseased sites. However, the sites showed no significant difference with respect to richness or diversity (p > 0.05). Our results indicate that CRS might be a polymicrobial infection, and also suggest that Corynebacterium and Staphylococcus may exist as commensals on the sinus mucosal surface in the upper respiratory tract.
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Abdalla A, Jamous F. Yellow Nail Syndrome: A Case Presentation and a Review of Management Options. SOUTH DAKOTA MEDICINE : THE JOURNAL OF THE SOUTH DAKOTA STATE MEDICAL ASSOCIATION 2021; 74:368-371. [PMID: 34461002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Yellow nail syndrome (YNS) has traditionally been thought of as a triad of exudative pleural effusion, yellow nails, and lymphedema. More recently, in addition to the hallmark yellowish nail discoloration, the diagnostic criteria required an associated lymphedema and/or chronic respiratory manifestations including pleural effusions, bronchiectasis or chronic sinusitis. Etiology remains unknown and treatment is supportive and directed towards patient's specific complaints. While described alongside multiple endocrine, lymphatic and autoimmune disorders, its most ominous association is malignancy, raising YNS as a possible paraneoplastic condition. Here we present the case of an 80 years-old female with worsening restrictive airway disease and acquired yellow nails, with development of dyspnea, cough and leg edema. Recurrent exudative lymphocyte predominant pleural effusion was treated definitively with pleurodesis. Her leg edema and yellow nails were treated conservatively. We describe previous case reports and series in the literature, outline therapeutic options and discuss prognosis.
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刘 肖, 刘 红, 李 春. [Advances in the study of chronic sinusitis microbiology using 16SrRNA gene sequencing technology]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:658-661. [PMID: 34304501 PMCID: PMC10127899 DOI: 10.13201/j.issn.2096-7993.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Indexed: 11/12/2022]
Abstract
Traditional conventional bacterial culture techniques can cultivate fewer types of bacteria, aiming to isolate and identify specific pathogens, guide antibiotic treatment and eradicate pathogens.Macrogenomics techniques can simultaneously identify both cultured and uncultured bacteria in the flora, providing the possibility for the study of symbiotic flora. With the vigorous development of SrRNA and application of 16 gene sequencing technology, the microbial ecology research of chronic sinusitis (chronic rhinosinusitis,CRS) has once again become a hot topic.And the CRS view of microbial community composition and microbial diversity were presented. This review describes the use of 16 SrRNA gene sequencing in recent years advances in technical studies CRS microbial ecology.
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Zhang H, Han N, Lin Y, Huang J, Svanberg S, Svanberg K. Gas Monitoring in Human Frontal Sinuses-Stability Considerations and Gas Exchange Studies. SENSORS 2021; 21:s21134413. [PMID: 34203142 PMCID: PMC8271500 DOI: 10.3390/s21134413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/14/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
Acute rhinosinusitis is a common infectious disease, which, in more than 90% of cases, is caused by viruses rather than by bacteria. Even so, antibiotics are often unnecessarily prescribed, and in the long run this contributes to the alarming level of antibiotics resistance. The reason is that there are no good guiding tools for defining the background reason of the infection. One main factor for the clearance of the infection is if there is non-obstructed ventilation from the sinus to the nasal cavity. Gas in Scattering Media Absorption Spectroscopy (GASMAS) has potential for diagnosing this. We have performed a study of frontal sinuses of volunteers with a focus on signal stability and reproducibility over time, accurate oxygen concentration determination, and assessment of gas transport through passages, naturally and after decongestant spray administration. Different from earlier studies on frontal sinuses, water vapor, serving the purpose of oxygen signal normalization, was measured at 818 nm rather than earlier at 937 nm, now closer to the 760 nm oxygen absorption band and thus resulting in more reliable results. In addition, the action of decongestants was objectively demonstrated for the first time. Evaluated oxygen concentration values for left- and right-hand side sinus cavities were found to agree within 0.3%, and a left-right geometrical asymmetry parameter related to anatomical differences was stable within 10%.
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Drobotun O, Stefanov N, Kolotilov N, Zazirny I. [HETEROGENEITY OF BRAIN TISSUE AS A DEATH PREDICTOR IN PATIENTS WITH MALIGNANT TUMORS]. GEORGIAN MEDICAL NEWS 2021:20-25. [PMID: 34365419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The measurement of the body tissues x-ray density for monitoring and predicting the course of the disease is used in neurology and oncology for timely treatment correction, choice of tactical or strategic therapeutic algorithms. The purpose of the article is to demonstrate the possibility of predicting a fatal outcome in patients with malignant femoral tumors with polymorbidity and malignant tumors of the paranasal sinuses based on the determination of brain tissue quantitative indicators. Patient groups: 1 - control group, 10 patients, 36-55 years with acute sinusitis; 2 - control group, 10 patients, 36-55 years with exacerbation of chronic sinusitis; 3 - 49 men, 30-65 years, after surgery for paranasal sinuses malignant tumors during the 1st remission; 4 - 12 men, 35-63 years, after surgery for paranasal sinuses malignant tumors who died during monitoring; 5 - 28 men, 44-68 years, after a femur malignant tumor radical removal and simultaneous arthroplasty during remission; 6 - 11 men, 39-62 years, after a femur malignant tumor radical removal with simultaneous arthroplasty and with polymorbid diseases (ischemic stroke, small vessel disease, arterial hypertension) who died during monitoring. X-ray density measurements (minimum - Dmin, arithmetic mean - Dam ± SD; maximum - Dmax) of the poles of the right and left temporal lobes were performed on the tomograms of the orbits and basal brain level. The tissue heterogeneity was determined by the formula: Kh = Dmax/Dmin. The observation period is 4 years. The left and right temporal lobes of the patients' groups 1 and 2 are symmetrical by Dam; differences between groups are practically unreliable (P> 0.05); in patients of groups 3 and 5, with a favorable course, the left and right temporal lobes are symmetrical by Dam; asymmetry of the Dam of the left and right temporal lobes is observed in patients of groups 4 and 6 with an unfavorable course of the disease. In this case, the Dam of the right temporal lobe is reliably (P <0.05) lower than the Dam of the left temporal lobe. The patients with malignant tumors of the femur and paranasal sinuses Kh is reliably higher (P <0.05) compared to the patients with inflammatory diseases of the paranasal sinuses. In patients with an unfavorable course of cancer, Kh of the right temporal lobe reliably (P<0.05) exceeds the corresponding indicator of the left temporal lobe. A decrease in x-ray density and an increase in tissue heterogeneity in the right temporal lobe of the brain in patients with malignant tumors of the femur and paranasal sinuses are associated with a fatal outcome within 23-265 days.
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Li E, Rodriguez A, Luong AU, Allen D, Knight JM, Kheradmand F, Corry DB. The immune response to airway mycosis. Curr Opin Microbiol 2021; 62:45-50. [PMID: 34052540 DOI: 10.1016/j.mib.2021.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 01/15/2023]
Abstract
The allergic airway diseases chronic rhinosinusitis (CRS), allergic fungal rhinosinusitis (AFRS), asthma, allergic bronchopulmonary mycosis/aspergillosis (ABPM/A), and cystic fibrosis (CF) share a common immunological signature marked by TH2 and TH17 cell predominant immune responses, the production of IgE antibody, and a typical inflammatory cell infiltrate that includes eosinophils and other innate immune effector cells. Severe forms of these disorders have long been recognized as being related to hypersensitivity reactions to environmental fungi. Increasingly however,environmental fungi are assuming a more primary role in the etiology of these disorders, with airway mycosis, a type of non-invasive airway fungal infection, recognized as an essential driving factor in at least severe subsets of allergic airway diseases. In this review, we consider recent progress made in understanding the immune mechanisms that drive airway mycosis-related diseases, improvements in immune-based diagnostic strategies, and therapeutic approaches that target key immune pathways.
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Tedla M, Suchankova M, Ahrendt K, Varga L, Frajkova Z, Urban J, Kluckova K, Tedlova E, Profant M, Bucova M. Triggering receptor expressed on myeloid cells 1 and 2 in patients with chronic maxillary sinusitis. ACTA ACUST UNITED AC 2021; 122:391-395. [PMID: 34002612 DOI: 10.4149/10.4149/bll_2021_065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE Chronic sinusitis can result from variable types of immune-mediated process, whose pathogenesis is not fully understood. Triggering receptors expressed on myeloid cells 1 and 2 (TREM-1, TREM-2) are involved in myeloid cell activation enabling these cells to fine-tune the inflammatory response, which may have an impact on subsequent adaptive immunity and may be the key factor in pathogenesis. The aim of the study was to analyse soluble TREM-1 and TREM-2 molecules in maxillary sinus lavage fluid and compare the defined subgroups selected from patients with chronic sinusitis with/without nasal polyps and allergy (asthma and allergic rhinitis). METHODS The levels of soluble TREM-1 and TREM-2 were measured by Elisa test in a cohort of patients with chronic maxillary sinusitis (n=45). We compared subgroups of patients with nasal polyps (n=33) and allergy (n=25: inclusive of asthma (n=11) and allergic rhinitis (n=14)) with the control group of patients without nasal polyps (n=13), and without allergy (n=21). RESULTS The study did not prove the difference between subgroups with and without nasal polyps. The levels of soluble TREM-1 did not differ significantly between patients with allergy (asthma and allergic rhinitis) and the control group without allergy (p=0.4804). The levels of soluble TREM-2 were significantly higher in patients with allergy (p=0.0028), asthma (p=0.0103) and allergic rhinitis (p=0.0137) as compared with the control group. CONCLUSION Our results suggest the role of TREM-2‑mediated activation of myeloid cells in chronic sinusitis accompanied by allergy, asthma, and allergic rhinitis (Tab. 6, Ref. 25).
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