Impact of cell culture methods on the outcomes of the in vitro inflammatory response in nasal polyps

BACKGROUND

In vitro culture of nasal polyp cells is frequently used in the investigation of inflammatory mechanisms and effect of treatments in nasal polyposis. Research outcomes may, however, be influenced by the culture methodology used.

METHODS

Nasal polyp and nasal mucosa in vitro fibroblast cultures were pre-treated with foetal bovine serum (FBS)-free culture medium or medium supplemented with either FBS or charcoal-stripped (cs) FBS. Cells were then stimulated with FBS or csFBS, with or without different doses of dexamethasone for 4 and 24h. IL-6, IL-8, GM-CSF and VEGF release and cell viability were measured.

RESULTS

The highest cytokine levels were found in growth-arrested cells stimulated with 10% FBS. csFBS poorly stimulated cytokine release. Nasal polyp released larger IL-8 amounts than nasal mucosa fibroblasts. Dexamethasone decreased cytokine production dose- and time-dependently in both nasal mucosa and nasal polyp fibroblasts. The IC25 of IL-8 inhibition by dexamethasone was higher in nasal polyp than in nasal mucosa fibroblasts. Cell viability did not differ among treatments.

CONCLUSIONS

Cytokine production by in vitro cultured nasal fibroblasts is affected by the culture conditions used and is inhibited by dexamethasone in both fibroblast types. Our results highlight the importance of culture methodology on nasal polyp research outcomes.

Persistent asthma has an accumulative impact on the loss of smell in patients with nasal polyposis

BACKGROUND

Loss of sense of smell is one of the most frequent complaints in patients with nasal polyposis (NP). The aim of this study was to evaluate the impact of asthma and its severity on the sense of smell.

MATERIAL AND METHODS

Patients with massive NP and healthy controls were included. More than half of patients presented with asthma. Olfactometry by Barcelona Smell Test 24, nasal symptoms score, nasal endoscopy, allergy study, and paranasal sinus CT scan were assessed.

RESULTS

NP patients showed a significant impairment in smell detection, identification, and forced choice compared to the control. Asthmatics reported lower scores for detection, identification, and forced choice than non-asthmatic patients. Patients with persistent asthma had an increased impairment of sense of smell on detection, identification, and forced choice than patients with intermittent asthma. No significant differences were found between mild, moderate, and severe persistent asthmatics. Paranasal sinuses opacification was inversely correlated with smell detection, identification and forced choice.

CONCLUSION

These findings suggest that patients with NP have an impaired sense of smell, that asthma -particularly persistent asthma- has a further impact on sense of smell, and that loss of smell may be used as a clinical tool to identify the severity of both NP and asthma.

European Position Paper on Rhinosinusitis and Nasal Polyps 2012

The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007.The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps and chronic rhinosinusitis with nasal polyps are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed.

Anatomic skull base education using advanced neuroimaging techniques

OBJECTIVE

The goal of the present article was to describe our dissection training system applied to a variety of endoscopic endonasal approaches. It allows one to perform a 3D virtual dissection of the desired approach and to analyze and quantify critical surgical measurements.

METHODS

All the human cadaveric heads were dissected at the Laboratory of Surgical Neuro-Anatomy (LSNA) of the University of Barcelona (Spain). The model surgical training protocol was designed as follows: 1) virtual dissection of the selected approach using our dissection training 3D model; 2) preliminary exploration of each specimen using a second 3D model based on a preoperative computed tomographic scan; 3) cadaveric anatomic dissection with the aid of a neuronavigation system; and 4) quantification and analysis of the collected data.

RESULTS

The virtual dissection of the selected approach, preliminary exploration of each specimen, a real laboratory dissection experience, and finally, the analysis of data retrieved during the dissection step was a complete method for training manual dexterity and hand-eye coordination and to improve the general knowledge of surgical approaches.

CONCLUSIONS

The present model results are found to be effective, providing a valuable representation of the surgical anatomy as well as a 3D visual feedback, thus improving study, design, and execution in a variety of approaches. Such a system can also be developed as a preoperative planning tool that will allow the neurosurgeon to practice and manipulate 3D representations of the critical anatomic landmarks involved in the endoscopic endonasal approaches to the skull base.

Furthering the understanding of olfaction, prevalence of loss of smell and risk factors: a population-based survey (OLFACAT study)

OBJECTIVES

To investigate olfaction in general population, prevalence of olfactory dysfunction and related risk factors.

DESIGN

Cross-sectional population-based survey, distributing four microencapsulated odorants (rose, banana, musk and gas) and two self-administered questionnaires (odour description; epidemiology/health status).

SETTING

The survey was distributed to general population through a bilingual (Catalan, Spanish) newspaper in Catalonia (Spain), on December 2003.

PARTICIPANTS

Newspaper readers of all ages and gender; 9348 surveys were analysed from the 10 783 returned.

MAIN OUTCOME MEASURES

Characteristics of surveyed population, olfaction by age and gender, smell self-perception and smell impairment risk factors. Terms normosmia, hyposmia and anosmia were used when participants detected, recognised or identified all four, one to three or none of the odours, respectively.

RESULTS

Survey profile was a 43-year-old woman with medium-high educational level, living in a city. Olfaction was considered normal in 80.6% (detection), 56% (recognition/memory) and 50.7% (identification). Prevalence of smell dysfunction was 19.4% for detection (0.3% anosmia, 19.1% hyposmia), 43.5% for recognition (0.2% anosmia, 43.3% hyposmia) and 48.8% for identification (0.8% anosmia, 48% hyposmia). Olfaction was worse (p<0.0001) in men than in women through all ages. There was a significant age-related smell detection decline however smell recognition and identification increased up to fourth decade and declined after the sixth decade of life. Risk factors for anosmia were: male gender, loss of smell history and poor olfactory self-perception for detection; low educational level, poor self-perception and pregnancy for recognition; and older age, poor self-perception and history of head trauma and loss of smell for identification. Smoking and exposure to noxious substances were mild protective factors for smell recognition.

CONCLUSIONS

Sense of smell in women is better than in men suggesting a learning process during life with deterioration in older ages. Poor self-perception, history of smell loss, head trauma and pregnancy are potential risk factors for olfactory disorders.

Endoscopic endonasal clipping of a ruptured vertebral-posterior inferior cerebellar artery aneurysm: technical case report

BACKGROUND AND IMPORTANCE

Aneurysms arising from the vertebral and posterior inferior cerebellar artery complex account for only 0.5 to 3% of all aneurysms. Surgery for these aneurysms is technically challenging because of the deep location and intimate relation with the medulla and lower cranial nerves. The authors report the case of a patient with a right vertebral-posterior inferior cerebellar artery complex (VA-PICA) aneurysm that was successfully clipped via an extended endoscopic endonasal transclival approach.

CLINICAL PRESENTATION

A 74-year-old woman with the sudden onset of severe headache, nausea, and vomiting was admitted to our hospital. A computed tomography (CT) of the brain revealed diffuse subarachnoid hemorrhage associated with intraventricular hemorrhage and incipient hydrocephalus. Cerebral angiography revealed a 1.2-mm aneurysm arising at the origin of the right PICA. The aneurysm was considered unsuitable for selective coil embolization, so neck clipping was performed. With the use of an extended endoscopic endonasal transclival approach, the aneurysm was accurately reached endoscopically and successfully clipped from the parent artery. The patient was discharged neurologically intact.

CONCLUSION

To the best of the authors' knowledge, this is the first report of a successfully treated VA-PICA ruptured aneurysm using a pure endoscopic endonasal transclival approach. Endoscopic surgery may be added to the armamentarium of procedures for the treatment of posterior circulation aneurysms.

Treatment of 183 Sinonasal Tumors: Updating Our Experience

Objective: The current study updated our previous study involving the outcomes and prognostic factors of sinonasal cancer patients treated at our institution.

Method: A total of 183 sinonasal cancer patients who were treated between 1974 and 2008 with a minimum follow-up of 2 years were retrospectively reviewed and restaged using the seventh edition of the AJCC staging manual.

Results: The mean age was 60.89 years (+14.99 years SD), 70.4% males. Tumor stage distribution was: T1:72patients; T2:48p; T3:39p; T4:24p. Ninety-six patients received surgery as primary treatment, 51 received surgery plus radiotherapy, 7 received surgery plus radiotherapy with/without chemotherapy, and 22 received radiotherapy with/without chemotherapy palliative treatment. The 1-, 5-, 10-year disease free survival rate was 82.3%, 49%, and 34.9%, respectively. There was no significant survival difference between surgery alone and surgery plus radiotherapy. The parameters with statistical prognostic significance were tumor stage, tumor histology, and locoregional failure.

Conclusion: Although there is a significant advance in survival rates, the failure at the primary site is still the main problem. As a prognostic value of survival, therefore, we should put all our effort to improve the control of the locoregional failure.

Increased cardiovascular and anxiety outcomes but not endocrine biomarkers of stress during performance of endoscopic sinus surgery: a pilot study among novice surgeons

OBJECTIVE

To compare psychophysiological responses among novice surgeons during performance of endoscopic sinus surgery (ESS).

DESIGN

Randomized study.

SETTING

Academic institution.

PARTICIPANTS

Fifteen novice surgeons.

MAIN OUTCOME MEASURES

The psychophysiological effects of performing ESS were assessed among 15 novice surgeons at 30 minutes before (T - 30), at the beginning of (T0), at 15 minutes (T15), and 45 minutes (T45) during, and at 30 minutes after (T + 30) surgery. Participants were randomized to perform ESS with a computer-assisted surgery system, to perform ESS without a computer-assisted surgery system, or to be evaluated on a nonsurgical day (control day). Measured were the State-Trait Anxiety Inventory score, Visual Analog Anxiety Scale score, heart rate, blood pressure, and plasma cortisol and prolactin levels.

RESULTS

Anxiety as measured by the State-Trait Anxiety Inventory score was not modified by the experimental conditions. The mean (SEM) Visual Analog Anxiety Scale score increased (P < .05) during ESS at T0 (2.45 [0.32]), T15 (3.46 [0.50]), and T45 (3.17 [0.46]) compared with the control day (1.19 [0.19], 1.32 [0.26], and 1.20 [0.19], respectively). The mean (SEM) systolic blood pressure (in millimeters of mercury) increased (P < .05) during ESS at T0 (127 [2]), T15 (126 [3]), and T45 (125 [2]) compared with the control day (120 [3], 119 [4], and 116 [3], respectively). The mean (SEM) heart rate (in beats per minute) increased during ESS but was significant only at T15 (73 [4]) compared with the control day (64 [3]). The mean (SEM) plasma cortisol level (in micrograms per deciliter) increased 29% above baseline during performance of ESS and reached a maximum peak at T45 (12.6 [1.2]) compared with the control day (9.7 [1.1]), while prolactin levels did not change. The Visual Analog Anxiety Scale score, heart rate, blood pressure, and endocrine biomarkers of stress were not significantly modified during performance of ESS with a computer-assisted surgery system.

CONCLUSION

This study demonstrates for the first time that cardiovascular and anxiety changes during performance of ESS are not associated with increased levels of prototypical endocrine stress hormones.

Diagnostic tools in Rhinology EAACI position paper

This EAACI Task Force document aims at providing the readers with a comprehensive and complete overview of the currently available tools for diagnosis of nasal and sino-nasal disease. We have tried to logically order the different important issues related to history taking, clinical examination and additional investigative tools for evaluation of the severity of sinonasal disease into a consensus document. A panel of European experts in the field of Rhinology has contributed to this consensus document on Diagnostic Tools in Rhinology.

The importance of smell in patients with bronchiectasis

BACKGROUND

The aim of the study was to evaluate the sense of smell in patients with bronchiectasis.

METHODS

Prospective controlled study was performed on 91 patients with bronchiectasis. Bronchiectasis patients were sub-classified depending on: the presence of chronic rhinosinusitis, with or without nasal polyps, and the bronchiectasis ethiology. Olfactory function was evaluated by means of the Barcelona Smell Test (BAST-24) olfactometry for detection, identification, and forced choice for the first and fifth cranial nerve dependent odours in comparison to a group of 120 healthy volunteers.

RESULTS

Most patients with bronchiectasis (80.2%) satisfied EP(3)OS criteria of chronic rhinosinusitis (CRS), and 26.4% presented nasal polyps (NP). Smell detection, identification, and forced choice tests were significantly (p < 0.001) worse in bronchiectasis patients than healthy controls for both the 1st and 5th CN. Among subgroups, patients with CRS presented a significant (p < 0.05) reduction in smell detection compared to both healthy controls and patients without CRS. Patients with both CRS and NP presented a significant (p < 0.01) reduction in both smell detection and forced choice compared to patients with CRS and without NP. Patients with bronchiectasis and primary humoral immunodeficiency had a poorer smell detection (p < 0.001) and forced choice (p < 0.001) compared with post-infective and idiopathic bronchiectasis patients.

CONCLUSIONS

Patients with bronchiectasis have a moderate loss of smell with a higher impairment in patients with CRS, being maximal in patients with NP. Patients with immunodeficiency bronchiectasis showed high prevalence of CRS, and therefore marked impairment on the sense of smell. The mechanism could be explained through a mixed ethiology (obstruction/inflammation).

Reduced expression of COXs and production of prostaglandin E(2) in patients with nasal polyps with or without aspirin-intolerant asthma

BACKGROUND

Researchers have debated whether regulation of the COX enzymes (COX-1 and COX-2), which mediate production of prostaglandins (PGs), affects the pathogenesis of nasal polyps (NPs) and aspirin-intolerant asthma (AIA).

OBJECTIVE

We investigated the roles of PGE(2), COX-1 and COX-2, and PGE(2) receptors in the development of NPs and AIA by measuring their expression in fibroblasts derived from nasal mucosa (NM) and NPs.

METHODS

Fibroblasts were isolated from the NM of subjects without asthma who had septal deviation, turbinate hypertrophy, or both (control subjects, n = 7); NPs of aspirin-tolerant nonasthmatic patients (n = 7); and NPs of patients with asthma who were intolerant of aspirin (n = 7). Polyp samples were collected during endoscopic surgery. Cultures were stimulated with IL-1β (10 ng/mL) for 72 hours. We used ELISA, immunoblotting, and immunofluorescence analyses to measure secretion of PGE(2), expression of COX-1 and COX-2, and expression of the PGE(2) receptors EP1 to EP4.

RESULTS

Compared with NM from control subjects, PGE(2) concentrations were significantly lower in IL-1β-stimulated fibroblasts from patients with NPs who were tolerant to aspirin and even lower in polyps from patients with AIA. Similarly, IL-1β exposure induced the expression of COX-1 and COX-2 in fibroblasts from NM of control subjects, had only moderate effects on fibroblasts from NPs of aspirin-tolerant nonasthmatic patients, and almost no effect on fibroblasts from NPs of patients with AIA. IL-1β also induced expression of EP2 in fibroblasts from control NM but not in fibroblasts from NPs of aspirin-tolerant nonasthmatic patients or those with AIA.

CONCLUSION

Alterations in the COX pathway (ie, reduced production of PGE(2) and lack of upregulation of COX-1, COX-2, and EP2 under conditions of inflammation) are associated with NPs in patients with or without AIA.

Mometasone and desloratadine additive effect on eosinophil survival and cytokine secretion from epithelial cells

Background

Although antihistamines and topical corticosteroids are used in combination to treat allergic rhinitis, their additive effect has not been yet demonstrated. The aim was investigate the antiinflammatory additive effect of mometasone and desloratadine on cytokine and sICAM-1 secretion by epithelial cells, and on eosinophil survival stimulated by human epithelial cells secretions from nasal mucosa and polyps.

Methods

Epithelial cells obtained from nasal mucosa or polyps were stimulated with 10% fetal bovine serum in presence of mometasone (10^-11M-10^-5M) with/without desloratadine (10^-5M). Cytokine and sICAM-1 concentrations in supernatants were measured by ELISA. Peripheral blood eosinophils were incubated during 4 days with epithelial cell secretions with (10^-11M-10^-5M) and/or desloratadine (10^-5M) and survival assessed by Trypan blue. Results are expressed as percentage (mean ± SEM) compared to control.

Results

Fetal bovine serum stimulated IL-6, IL-8, GM-CSF and sICAM-1 secretion. In mucosa and polyp epithelial cells, mometasone inhibited this induced secretion while desloratadine inhibited IL-6 and IL-8. The combination of 10^-5M desloratadine and 10^-9M mometasone reduced IL-6 secretion (48 ± 11%, p < 0.05) greater extent than mometasone alone (68 ± 10%) compared to control (100%). Epithelial cell secretions induced eosinophil survival from day 1 to 4, this effect being inhibited by mometasone. At day 4, the combination of mometasone (10^-11M) and desloratadine (10^-5M) provoked an increased inhibition of eosinophil survival induced by cell secretions (27 ± 5%, p < 0.01) than mometasone (44 ± 7%) or desloratadine (46 ± 7%) alone.

Conclusions

These results suggest that the combination of desloratadine and mometasone furoate have a greater antinflammatory effect in an in vitro model of eosinophil inflammation than those drugs administered alone.

Nuclear translocation of the glucocorticoid receptor in fibroblasts of asthmatic patients with nasal polyposis insensitive to glucocorticoid treatment

BACKGROUND

Nasal polyposis (NP) is treated with topical glucocorticoids (GC). Some patients require endoscopic nasal surgery because GC treatment is ineffective. To exert its function, the GC needs to bind with the GC receptor (GR) and the GC-GR complex moves to the cell nucleus. Our aim was to establish whether the poor response to GC is due to an alteration in the translocation of the GR to the nucleus.

METHODS

We performed nasal fibroblast cell cultures from seven healthy controls and 12 patients with NP and asthma. Fibroblasts were incubated with budesonide or dexamethasone (10(-7) M) for different times (30 min to 4 h) and GR translocation was analyzed by immunocytochemistry.

RESULTS

Both GC induced GR translocation in every group, doubling its concentration in the cell nucleus (30 min) compared to baseline. There were no differences in GR translocation between controls and patients, nor differences related to the severity of asthma or intolerance to non-steroidal anti-inflammatory drugs (NSAIDs). Atopic subjects showed a decrease in GR translocation with budesonide (1 h, 3 h and 4 h, P<0.05) and dexamethasone (30 min and 2 h, P<.05).

CONCLUSIONS

The insensitivity to GC treatment does not appear to be due to an alteration in GR translocation to the nucleus. Neither does the severity of asthma or intolerance to NSAIDs appear to alter GR translocation. The association between atopy and the alteration in GR function deserves further investigation.

Neurosurgeon-otolaryngologist collaboration in endonasal approaches to the clivus and suprasellar region

Lesions in the clivus and suprasellar region are rare but challenging pathologies for physicians. The most common tumours are chordomas and chondrosarcomas, but a wide variety of histopathological tumours can be found in these areas. Their deep location in the midline and their close relationship to important neurovascular structures frequently make total removal difficult. Neurosurgeons are often required to perform aggressive external-approach surgical therapy, which is usually associated with high levels of morbidity and a discouraging tendency for recurrence during long-term follow-up. Fortunately, over the past few years, close collaboration between otorhinolaryngologists and neurosurgeons has led to the development of minimally invasive surgery along the entire neuraxis, with endoscopy being used as the primary visualisation tool. This has been further augmented by the concept of team surgery: ENT surgeons and neurosurgeons working simultaneously throughout all phases of the surgery (approach, resection, and reconstruction). This concept has also changed the surgical approach as a whole, making the endonasal route the main approach for treating these types of lesions in carefully selected patients and external approaches the second-place option. The endonasal approach has revolutionised skull base surgery as it enables less aggressive surgery (reaching deep-seated structures without the need for craniotomy and brain retraction). It is therefore associated with lower morbidity and an absence of visible scars, with encouraging initial oncological prognosis. The aims of this paper are to describe the anatomical landmarks for this approach, to relate our experiences and to provide a literature review.

Controversies in the treatment of chronic rhinosinusitis

Chronic rhinosinusitis (CRS) including nasal polyps is a chronic inflammatory disease involving the mucosa of the nose and one or more paranasal sinuses. Despite differing hypotheses, the cause remains poorly understood. The key issue is the maintaining of ostial patency. CRS with nasal polyps is considered to be a subgroup of CRS. Major symptoms are nasal congestion or blockage, loss of smell, rhinorrhea, post-nasal drip, and facial pain or pressure. CRS is associated with lower airway disease such asthma, chronic obstructive pulmonary disease and bronchiectasis. In CRS with and without nasal polyps, medical treatment, including nasal and oral corticosteroids, is the first therapeutic option. The treatment of CRS still remains an unmet need. Corticosteroids are the mainstay of treatment and are the most effective drugs for treating airway inflammatory diseases such as asthma, allergic rhinitis and CRS. Endoscopic sinus surgery is only recommended when medical treatment fails. After surgery, medical treatment, including nasal and oral corticosteroids, is recommended.

Montelukast reduces eosinophilic inflammation by inhibiting both epithelial cell cytokine secretion (GM-CSF, IL-6, IL-8) and eosinophil survival

Leukotriene receptor antagonists, such as montelukast (MK), are currently used to treat rhinitis and asthma, but their anti-inflammatory role in eosinophil inflammation is not well understood. The aim of this study is to investigate the effect of MK on an in vitro model of upper-airway eosinophil inflammation by reducing pro-inflammatory cytokines from both nasal mucosa (NM) and polyp (NP) epithelial cells and reducing eosinophil survival primed by epithelial cell secretions. Epithelial cells were stimulated with fetal bovine serum (FBS) with or without MK for 24 hours, and cytokine concentrations in epithelial secretions were measured by ELISA. After incubating peripheral blood eosinophils with epithelial cell-conditioned media (ECM) with or without MK up to 3 days, eosinophil survival was assessed by Trypan blue dye exclusion. Results are expressed as mean±SEM of cytokine concentration (percent of control) or eosinophil survival (percent). Epithelial cell stimulation increased GM-CSF, IL-6, IL-8, and sICAM-1 secretion in both NM and NP. MK had a significant inhibitory effect on FBS-induced GM-CSF, IL-6, and IL-8 secretion, but not sICAM-1, in both NM and NP. MK also showed an inhibitory effect (p<0.05) on ECM-induced eosinophil survival from both NM (from 10(-5)M to 10(-7)M, n=7) and NP (at 10(-5)M, n=7), after 3 days of incubation. These anti-inflammatory effects on epithelial cell cytokine secretion and on eosinophil survival suggest that montelukast may contribute to the reduction of eosinophilic inflammation in upper-airway inflammatory diseases such as rhinitis and nasal polyposis.