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Berkiten G, Şengiz Erhan S, Çelik C, Tutar B, Atar Y, Aksungur E, Sari H, Uyar Y. An assessment of the effects of adenoid hypertrophy on mucociliary clearance and nasal cytology in children. Int J Pediatr Otorhinolaryngol 2023; 174:111718. [PMID: 37722297 DOI: 10.1016/j.ijporl.2023.111718] [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: 04/13/2023] [Revised: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023]
Abstract
AIM/OBJECTIVE The aim of this study was to demonstrate the benefits of the systematic use of nasal cytology and mucociliary clearance in the diagnostic workup of nasal disorders in children with adenoid hypertrophy (AH) to reach a well-defined diagnosis, establish a rational therapeutic approach, avert from complications, and develop the patient's life quality. MATERIALS/METHODS In this prospective study, a total of 61 pediatric patients (aged 5-12 years) were evaluated. The case group consisted of 31 children with AH symptoms, while the control group comprised 30 children without AH symptoms.Exclusions included previous adenoidectomy/adenotonsillectomy, cardiovascular/neurological diseases, acute/allergic rhinitis, genetic disorders (e.g., Down syndrome), and immunodeficiency. The control group consisted of children without nasal obstruction symptoms and without AH, who admitted for various reasons. Medical history, examinations, fiberoptic nasopharyngoscopy, cephalometric evaluations, AST, and nasal cytology were conducted. RESULTS At the end of the study, a significant increase in the mucociliary clearance time was observed in the group with AH compared to the control group (p < 0.05). Although AH may disrupt MCC, there is no correlation between the size of the hypertrophy and MCC time.When the distribution of cells in the nasal cytology is evaluated, no difference was detected between the AH group and control groups. CONCLUSION Nasal mucociliary clearance has been found to be decreased, particularly in the presence of significant AH.
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Affiliation(s)
- Güler Berkiten
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Selma Şengiz Erhan
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Pathology, Istanbul, Turkey
| | - Cem Çelik
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Belgin Tutar
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Yavuz Atar
- Uskudar University, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Elif Aksungur
- Iğdır Dr.Nevruz Erez State Hospital, Department of Otorhinolaryngology, Iğdır, Turkey
| | - Hüseyin Sari
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Yavuz Uyar
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
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Toro MDC, Ortiz E, Marson FAL, Pinheiro LM, Toro AADC, Ribeiro JD, Sakano E. Cross-sectional evaluation of the saccharin transit time test for primary ciliary dyskinesia: did we discard this tool too soon? SAO PAULO MED J 2023; 141:e2022508. [PMID: 37194765 DOI: 10.1590/1516-3180.2022.0508.r2.13032023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/13/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a rare and heterogeneous disease that is difficult to diagnose and requires complex and expensive diagnostic tools. The saccharin transit time test is a simple and inexpensive tool that may assist in screening patients with PCD. OBJECTIVES This study aimed to compare changes in the electron microscopy findings with clinical variables and saccharin tests in individuals diagnosed with clinical PCD (cPCD) and a control group. DESIGN AND SETTING An observational cross-sectional study was conducted in an otorhinolaryngology outpatient clinic from August 2012 to April 2021. METHOD Patients with cPCD underwent clinical screening questionnaires, nasal endoscopy, the saccharin transit time test, and nasal biopsy for transmission electron microscopy. RESULTS Thirty-four patients with cPCD were evaluated. The most prevalent clinical comorbidities in the cPCD group were recurrent pneumonia, bronchiectasis, and chronic rhinosinusitis. Electron microscopy confirmed the clinical diagnosis of PCD in 16 of the 34 (47.1%) patients. CONCLUSION The saccharin test could assist in screening patients with PCD due to its association with clinical alterations related to PCD.
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Affiliation(s)
- Mariana Dalbo Contrera Toro
- MD, MSc. PhD Student, Department of Otolaryngology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Erica Ortiz
- MD, PhD. Physician, Department of Otolaryngology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Fernando Augusto Lima Marson
- MD, PhD. Physician, Department of Pediatrics, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil; Researcher, Laboratory of Medical Genetics and Genome Medicine, Department of Medical Genetics, Faculty of Medical Sciences, UNICAMP, Campinas (SP), Brazil; Professor, Laboratory of Human and Medical Genetics, Universidade São Francisco, Bragança Paulista (SP), Brazil
| | - Laíza Mohana Pinheiro
- MD. Physician, Department of Otolaryngology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Adyléia Aparecida Dalbo Contrera Toro
- MD, PhD. Adjunct Professor, Department of Pediatrics, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - José Dirceu Ribeiro
- MD, PhD. Pediatric Pulmonologist and Full Professor, Department of Pediatrics, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Eulália Sakano
- MD, PhD. Adjunct Professor, Department of Otolaryngology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
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Blanco-Máñez R, Armengot-Carceller M, Jaijo T, Vera-Sempere F. Axonemal Symmetry Break, a New Ultrastructural Diagnostic Tool for Primary Ciliary Dyskinesia? Diagnostics (Basel) 2022; 12:diagnostics12010129. [PMID: 35054295 PMCID: PMC8774754 DOI: 10.3390/diagnostics12010129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/27/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
Diagnosis testing for primary ciliary dyskinesia (PCD) requires a combination of investigations that includes study of ciliary beat pattern by high-speed video-microscopy, genetic testing and assessment of the ciliary ultrastructure by transmission electron microscopy (TEM). Historically, TEM was considered to be the “gold standard” for the diagnosis of PCD. However, with the advances in molecular genetic techniques, an increasing number of PCD variants show normal ultrastructure and cannot be diagnosed by TEM. During ultrastructural assessment of ciliary biopsies of patients with suspicion of PCD, we observed an axonemal defect not previously described that affects peripheral doublets tilting. To further characterize this defect of unknown significance, we studied the ciliary axonemes by TEM from both PCD-confirmed patients and patients with other sino-pulmonary diseases. We detected peripheral doublets tilting in all the PCD patients, without any significant difference in the distribution of ciliary beat pattern or mutated gene. This defect was also present in those patients with normal ultrastructure PCD subtypes. We believe that the performance of axonemal asymmetry analysis would be helpful to enhance diagnosis of PCD.
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Affiliation(s)
- Rosana Blanco-Máñez
- Pathology Department, La Fe Polytechnic and University Hospital, 46020 Valencia, Spain
- Correspondence:
| | - Miguel Armengot-Carceller
- Molecular, Cellularand Genomic Biomedicine Group, IIS La Fe, 46020 Valencia, Spain; (M.A.-C.); (T.J.)
- Surgery Department, University of Valencia, 46010 Valencia, Spain
- CIBER of Respiratory Diseases (CIBERES), Carlos III Health Institute, Ministerio de Ciencia e Innovación, 28029 Madrid, Spain
- ENT Department, La Fe Polytechnic and University Hospital, 46020 Valencia, Spain
| | - Teresa Jaijo
- Molecular, Cellularand Genomic Biomedicine Group, IIS La Fe, 46020 Valencia, Spain; (M.A.-C.); (T.J.)
- Genetics Department, La Fe Polytechnic and University Hospital, 46020 Valencia, Spain
- CIBER of Rare Diseases (CIBERES), Carlos III Health Institute, Ministerio de Ciencia e Innovación, 28029 Madrid, Spain
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4
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Gurov AV, Yushkina MA, Doronina OM. [Features of topical therapy of inflammatory pathology of nasal cavity]. Vestn Otorinolaringol 2022; 87:79-83. [PMID: 36107185 DOI: 10.17116/otorino20228704179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Treatment of inflammatory pathology of the nasal cavity at the present stage requires a doctor to clearly understand the physiological mechanisms that implement the main functions of the mucous membrane of the nasal cavity and upper respiratory tract. One of the most important processes that ensure the normal functioning of the respiratory tract is mucociliary clearance. Violations of its work leads to stagnation of mucus and the development of inflammation not only in the nasal cavity, but also in the lower respiratory tract and middle ear cavities. The authors of the article consider the main etiological factors and mechanisms of the pathogenesis of inflammatory diseases of the nasal cavity, discuss approaches to the treatment of these conditions. The authors conclude that in conditions of acute and chronic inflammation of the nasal mucosa, accompanied by the secretion of thick viscous mucus, the most effective topical use of the combined preparation, which includes acetylcysteine, tuaminoheptane and sodium hyaluronate. This combination has both mucolytic, vasoconstrictive and protective effects, which increases the effectiveness of the drug and the adherence of patients to therapy.
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Affiliation(s)
- A V Gurov
- Pirogov Russian National Research Medical University, Moscow, Russia
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Yushkina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - O M Doronina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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5
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Alekseenko S, Karpischenko S, Barashkova S. Comparative Analysis of Mucociliary Clearance and Mucosal Morphology Using High-Speed Videomicroscopy in Children With Acute and Chronic Rhinosinusitis. Am J Rhinol Allergy 2021; 35:656-663. [PMID: 33467866 DOI: 10.1177/1945892420988804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE evaluation of mucociliary clearance and mucosal morphology using high-speed videomicroscopy, and their association with markers of disease severity in children with acute (ARS) and chronic rhinosinusitis (CRS). METHODS A total of 67 children aged from 6 to 17 years including 15 healthy children, 20 pediatric patients with acute rhinosinusitis, and 32 cases with chronic rhinosinusitis were enrolled in the present study. SNOT20, Lund-Kennedy, and Lund-Mackay scores were also evaluated. RESULTS Children with rhinosinusitis were characterized by significantly lower number of cells with motile cilia, ciliary beat frequency, cilia length, and cell viability, as well as ciliary beat asynchrony, epithelia dystrophy and reduced epithelial cell height, being more severe in ARS group. Neutrophil infiltration of sinonasal mucosa was more profound in children with ARS, whereas the number of lymphocytes was significantly reduced. Markers of ciliary function were characterized by a significant correlation with epithelia dystrophia and neutrophil infiltration. Discriminant analysis demonstrated significant group separation based on the parameters of mucociliary clearance and mucosal morphology. In regression models mucociliary function was also associated with SNOT20, Lund-Kennedy, and Lund-Mackay scores. CONCLUSION The results of the present study demonstrate significant alteration of mucociliary clearance and mucosal morphology and its association with sinonasal inflammation and disease severity in patients with rhinosinusitis. Given a tight association between altered mucociliary clearance and severity of the disease, modulation of inflammation and ciliary function both in acute and chronic rhinosinusitis may be considered as the potential tool in therapeutic and surgical management of the disease.
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Affiliation(s)
- Svetlana Alekseenko
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia.,I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia.,K.A. Rauhfus Children's City Multidisciplinary Clinical Center for High Medical Technologies, St. Petersburg, Russia
| | - Sergey Karpischenko
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia.,K.A. Rauhfus Children's City Multidisciplinary Clinical Center for High Medical Technologies, St. Petersburg, Russia.,First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Svetlana Barashkova
- K.A. Rauhfus Children's City Multidisciplinary Clinical Center for High Medical Technologies, St. Petersburg, Russia.,National Center of morphological diagnostic, St. Petersburg, Russia
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Pang C, An F, Yang S, Yu N, Chen D, Chen L. In vivo and in vitro observation of nasal ciliary motion in a guinea pig model. Exp Biol Med (Maywood) 2020; 245:1039-1048. [PMID: 32434378 DOI: 10.1177/1535370220926443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPACT STATEMENT Cilia play an important role in the airway defense mechanism. So far, studies on ciliary function have mainly been based on in vitro methods. Images of in vivo ciliary motion are very difficult to capture. In this study, we describe a novel approach to observe and analyze nasal ciliary motion in living animals with comparison to in vitro observation. Such images of ciliary motion from living animals have not been reported to date. The result of the study indicates that in vivo ciliary physiological function differs from ex vivo and in vitro conditions in many ways, such as the stability over time and response to temperature variation. This is a good foundation for further in vivo analysis of airway ciliary physiological function in animals as well as humans.
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Affiliation(s)
- Chuan Pang
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing 100853, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing 100853, China
| | - Fengwei An
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing 100853, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing 100853, China
| | - Shiming Yang
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing 100853, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing 100853, China
| | - Ning Yu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing 100853, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing 100853, China
| | - Daishi Chen
- Department of Otorhinolaryngology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen 518020, China
| | - Lei Chen
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing 100853, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing 100853, China
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7
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Motile Ciliary Disorders in Chronic Airway Inflammatory Diseases: Critical Target for Interventions. Curr Allergy Asthma Rep 2018; 18:48. [PMID: 30046922 DOI: 10.1007/s11882-018-0802-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Impaired mucociliary clearance has been implicated in chronic upper and lower airway inflammatory diseases (i.e., allergic and non-allergic rhinitis, chronic rhinosinusitis with or without nasal polyps and asthma). How motile ciliary disorders (impaired ciliogenesis, ciliary beating and ultrastructural defects) are implicated in chronic airway inflammatory diseases is not fully understood. Elaboration of the role of motile ciliary disorders may serve as therapeutic targets for improving mucociliary clearance, thereby complementing contemporary disease management. RECENT FINDINGS We have summarized the manifestations of motile ciliary disorders and addressed the underlying associations with chronic airway inflammatory diseases. A panel of established and novel diagnostic tests and therapeutic interventions are outlined. Physicians should be vigilant in screening for motile ciliary disorders, particularly in patients with co-existing upper and lower airway inflammatory diseases. Proper assessment and treatment of motile ciliary disorders may have added value to the management and prevention of chronic airway inflammatory diseases.
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8
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Mitchison HM, Shoemark A. Motile cilia defects in diseases other than primary ciliary dyskinesia: The contemporary diagnostic and research role for transmission electron microscopy. Ultrastruct Pathol 2017; 41:415-427. [PMID: 28925789 DOI: 10.1080/01913123.2017.1370050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Ultrastructural studies have underpinned the cell biological and clinical investigations of the varied roles of motile cilia in health and disease, with a long history since the 1950s. Recent developments from transmission electron microscopy (TEM; cryo-electron microscopy, electron tomography) have yielded higher resolution and fresh insights into the structure and function of these complex organelles. Microscopy in ciliated organisms, disease models, and in patients with ciliopathy diseases has dramatically expanded our understanding of the ubiquity, multisystem involvement, and importance of cilia in normal human development. Here, we review the importance of motile cilia ultrastructural studies in understanding the basis of diseases other than primary ciliary dyskinesia.
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Affiliation(s)
- Hannah M Mitchison
- a Newlife Birth Defects Research Centre, Experimental and Personalised Medicine, Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health , University College London , London , UK
| | - Amelia Shoemark
- b Department of Paediatric Respiratory Medicine , Royal Brompton & Harefield NHS Trust , London , UK.,c Division of Molecular & Clinical Medicine, School of Medicine , Ninewells Hospital and Medical School , Dundee , UK
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Dixon M, Shoemark A. Secondary defects detected by transmission electron microscopy in primary ciliary dyskinesia diagnostics. Ultrastruct Pathol 2017; 41:390-398. [PMID: 28922056 DOI: 10.1080/01913123.2017.1365990] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary ciliary dyskinesia (PCD) is predominantly an autosomal recessively inherited condition that affects ~1 in 15,000 people. Diagnosis of PCD can be complex and is ordinarily based on the results of multiple investigations. These investigations include nasal nitric oxide, high-speed video microscopy, genotyping, and electron microscopy analysis of ciliary ultrastructure. A diagnosis is ultimately confirmed by the presence of a hallmark defect identified by transmission electron microscopy or biallelic variants in a known PCD gene. Secondary ciliary defects are commonly seen in samples submitted for diagnosis of PCD. Acquired secondary ciliary ultrastructural abnormalities, which are not caused by a variant in a ciliary gene, are usually transient and reversible however failure to separate primary versus secondary defects can lead to misdiagnosis. In this review, we describe causes of secondary ciliary defects, identify the ultrastructural appearances associated with secondary ciliary dyskinesia and finally suggest methods to avoid misdiagnosis of PCD due to these acquired ciliary defects.
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Affiliation(s)
- Mellisa Dixon
- a Department of Paediatrics , Royal Brompton Hospital , London , United Kingdom
| | - Amelia Shoemark
- a Department of Paediatrics , Royal Brompton Hospital , London , United Kingdom.,b School of Medicine , University of Dundee, Ninewells Hospital and Medical School , Dundee , United Kingdom
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10
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Miranda IC, Granick JL, Armién AG. Histologic and Ultrastructural Findings in Dogs With Chronic Respiratory Disease Suspected of Ciliary Dyskinesia. Vet Pathol 2017; 54:802-812. [PMID: 28494707 DOI: 10.1177/0300985817705170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mucociliary clearance is a main defense mechanism of the respiratory tract, which can be inherently impaired in primary ciliary dyskinesia (PCD) or reversibly altered in secondary ciliary dyskinesia (SCD). Limited diagnostic test availability likely leads to misdiagnosis or underdiagnosis of PCD in animals. This study evaluated the light and transmission electron microscopy (TEM) changes in the respiratory mucosa of 15 dogs with chronic respiratory disease suspected of PCD. Necropsy was performed in 1 case and 2 dogs were used as negative controls. PCD was confirmed in 1 dog, which presented with chronic otitis, bronchopneumonia, hydrocephalus and ultrastructural abnormalities in 84% of the assessed cilia, including absence of dynein arms and microtubular changes. The 14 other cases showed only nonspecific alterations, such as ciliary disorientation, compound cilia, ciliary edema, and axoneme bubbles in a minority of the evaluated cilia and were classified as SCD. Ciliary ultrastructural analysis can confirm a diagnosis of PCD if specific abnormalities exist. TEM remains an important investigational tool in veterinary medicine, as no other specific test for PCD in dogs has been standardized yet.
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Affiliation(s)
- Ileana C Miranda
- 1 Department of Epidemiology and Public Health, Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropedica, Rio de Janeiro, Brazil.,2 Ultrastructural Pathology Unit, Veterinary Diagnostic Laboratory, University of Minnesota, Saint Paul, MN, USA
| | - Jennifer L Granick
- 3 Veterinary Clinical Sciences Department, University of Minnesota, Saint Paul, MN, USA
| | - Anibal G Armién
- 2 Ultrastructural Pathology Unit, Veterinary Diagnostic Laboratory, University of Minnesota, Saint Paul, MN, USA
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Amirav I, Roduta Roberts M, Mussaffi H, Mandelberg A, Roth Y, Abitbul R, Luder A, Blau H, Alkrinawi S, Aviram M, Ben-Ami M, Rotschild M, Bentur L, Shoseyov D, Cohen-Cymberknoh M, Kerem E, Avital A, Springer C, Hevroni A, Dabbah H, Elizur A, Picard E, Goldberg S, Rivlin J, Livnat G, Lavie M, Alias N, Soferman R, Olbrich H, Raidt J, Wallmeier J, Werner C, Loges NT, Omran H. Collecting clinical data in primary ciliary dyskinesia- challenges and opportunities. F1000Res 2016; 5:2031. [PMID: 27781089 PMCID: PMC5022703 DOI: 10.12688/f1000research.9323.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 11/20/2022] Open
Abstract
Rationale: Primary ciliary dyskinesia (PCD) is under diagnosed and underestimated. Most clinical research has used some form of questionnaires to capture data but none has been critically evaluated particularly with respect to its end-user feasibility and utility. Objective: To critically appraise a clinical data collection questionnaire for PCD used in a large national PCD consortium in order to apply conclusions in future PCD research. Methods: We describe the development, validation and revision process of a clinical questionnaire for PCD and its evaluation during a national clinical PCD study with respect to data collection and analysis, initial completion rates and user feedback. Results: 14 centers participating in the consortium successfully completed the revised version of the questionnaire for 173 patients with various completion rates for various items. While content and internal consistency analysis demonstrated validity, there were methodological deficiencies impacting completion rates and end-user utility. These deficiencies were addressed resulting in a more valid questionnaire. Conclusions: Our experience may be useful for future clinical research in PCD. Based on the feedback collected on the questionnaire through analysis of completion rates, judgmental analysis of the content, and feedback from experts and end users, we suggest a practicable framework for development of similar tools for various future PCD research.
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Affiliation(s)
- Israel Amirav
- Department of Pediatrics, University of Alberta, Edmonton, Canada; Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Huda Mussaffi
- Schneider Children's Medical Center of Israel, Tel Aviv, Israel
| | | | - Yehudah Roth
- The Edith Wolfson Medical Center, Tel Aviv University, Holon, Israel
| | - Revital Abitbul
- Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Anthony Luder
- Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Hannah Blau
- Schneider Children's Medical Center of Israel, Tel Aviv, Israel
| | | | | | - Marta Ben-Ami
- Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | | | - David Shoseyov
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | | | - Eitan Kerem
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Avraham Avital
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Chaim Springer
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Avigdor Hevroni
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Husein Dabbah
- Galilee Medical Center, Naharia, Bar Ilan Faculty of Medicine, Safed, Israel
| | | | - Elie Picard
- Shaare Zedek Medical Center, Jerusalem, Israel
| | | | | | | | - Moran Lavie
- Sheba Medical Center , Tel Aviv University, Tel Aviv, Israel
| | | | | | - Heike Olbrich
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Johanna Raidt
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Julia Wallmeier
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Claudius Werner
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Niki T Loges
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Heymut Omran
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
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12
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Tint D, Kubala S, Toskala E. Risk Factors and Comorbidities in Chronic Rhinosinusitis. Curr Allergy Asthma Rep 2016; 16:16. [PMID: 26800681 DOI: 10.1007/s11882-015-0589-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic rhinosinusitis (CRS) is a heterogeneous disorder that creates a significant burden on the healthcare system. It is caused by a combination of inflammatory, environmental, and host factors; however, the precise mechanism of how each factor leads to CRS continues to be a source of debate. Previous data regarding this topic is often inconsistent or of lower quality. In this article, we review the recent literature on the risk factors and comorbidities in CRS. Large population-based studies have helped establish smoking as a significant risk factor for CRS. The focus has now shifted towards smoking and its effect on long-term outcomes after endoscopic sinus surgery (ESS). Ciliary dyskinesia, both primary and secondary, can affect both the sinonasal cavity and lower airways simultaneously by decreasing the beat frequency of cilia and inducing mucostasis. The effects of secondary dyskinesia may be reversible and there is some evidence to suggest the use of topical mucolytics in patients with CRS. Allergy and variants of sinonasal anatomy have been hypothesized to increase the risk of developing CRS by inducing chronic inflammation and obstructing the sinus ostia. Nevertheless, emerging data regarding these topics continue to produce inconclusive results. Inflammation of the upper and lower airways can occur simultaneously as seen in patients with asthma and aspirin sensitivity. The connection between these pro-inflammatory disease states has been known for many years. Newer evidence include large population-based studies and studies that correlate objective tests, such as computer tomography scans to pulmonary function tests. However, the treatment of CRS and its effects on obstructive airway disease continues to be a topic of debate. More large prospective studies are needed in order to continue refining our knowledge of the disease processes in CRS.
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Affiliation(s)
- Derrick Tint
- Temple Head & Neck Institute, 3440 N. Broad Street, Kresge West 3rd Floor, Philadelphia, PA, 19140, USA
| | - Stephanie Kubala
- Lewis Katz School of Medicine at Temple University, 3500 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Elina Toskala
- Temple Head & Neck Institute, 3440 N. Broad Street, Kresge West 3rd Floor, Philadelphia, PA, 19140, USA.
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Orimo K, Kondo M, Arimura K, Takeyama K, Takeuchi K, Tamaoki J. Primary ciliary dyskinesia with complex abnormalities including cleavage of B-subfibers. Respirol Case Rep 2016; 4:e00150. [PMID: 27081490 PMCID: PMC4818581 DOI: 10.1002/rcr2.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 11/23/2022] Open
Abstract
A 25‐year‐old Japanese woman suffered from repeated respiratory tract infections. Because of her characteristic medical history and imaging findings, we suspected primary ciliary dyskinesia (PCD) and performed a transbronchial biopsy. The biopsy revealed complex abnormalities of the ciliary structure including cleavage of the B‐subfibers observed by transmission electron microscopy analysis and the complete loss of ciliary motion by video analysis. Genetic examinations to diagnose PCD have progressed in recent years. However, in this case, the well‐known genetic mutations in causal genes of PCD were not detected via whole‐exome sequencing of the blood. Cleavage of the B‐subfibers in patients with PCD has never been reported. This case appears to be the first report of this PCD subtype in humans.
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Affiliation(s)
- Keisuke Orimo
- First Department of Medicine Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Mitsuko Kondo
- First Department of Medicine Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Ken Arimura
- First Department of Medicine Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Kiyoshi Takeyama
- First Department of Medicine Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology Head and Neck Surgery Mie University Graduate School of Medicine Tsu Japan
| | - Jun Tamaoki
- First Department of Medicine Tokyo Women's Medical University School of Medicine Tokyo Japan
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14
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Yazıcı H. Nasal Mucociliary Clearance in Adenoid Hypertrophy and Otitis Media with Effusion. Curr Allergy Asthma Rep 2016; 15:74. [PMID: 26496764 DOI: 10.1007/s11882-015-0576-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mucociliary clearance (MCC), which exists in many systems, is the first defensive mechanism of the human body. Nasal MCC has an important role in transporting the secretions of the nasal cavity and paranasal sinuses along with the trapped inhaled pathogens to the nasopharynx. Physiologic or pathologic situations that effect nasal MCC, such as temperature, humidity, nasal obstruction, allergic rhinitis, chronic infections, etc., lead to impaired MCC and related local or circumjacent system disorders. With this perspective, when a unified airway with a multiple disease principle is considered, investigating the relationship between adenoid hypertrophy (AH), otitis media with effusion (OME) and nasal MCC is logical. In this review, histological and physiologic properties of nasal MCC and its possible role involving pathologic situations such as AH and OME is discussed together with recent literature findings.
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Affiliation(s)
- Hasmet Yazıcı
- Balikesir University Faculty of Medicine Ear Nose Throat Clinic, Mimar sinan Cad. Eylül sitesi B Blok Kat3 No: 5, Balikesir, Turkey, 10000.
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15
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Takeuchi K, Kitano M, Ishinaga H, Kobayashi M, Ogawa S, Nakatani K, Masuda S, Nagao M, Fujisawa T. Recent advances in primary ciliary dyskinesia. Auris Nasus Larynx 2015; 43:229-36. [PMID: 26527516 DOI: 10.1016/j.anl.2015.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 09/02/2015] [Accepted: 09/30/2015] [Indexed: 01/30/2023]
Abstract
Primary ciliary dyskinesia (PCD) is a genetic disease inherited in an autosomal recessive manner. The prevalence of PCD is estimated to be 1 in 20,000 live births. Congenital abnormality of the primary cilia results in situs inversus in 50% of patients. Decreased function of motile cilia causes chronic rhinosinusitis, otitis media with effusion, bronchiectasis and infertility. Cases with situs inversus are considered to show "Kartagener's syndrome", and diagnosis is not difficult. However, in cases without situs inversus, the diagnosis is much more troublesome. PCD without situs inversus is thus probably underdiagnosed. Prolonged chronic cough represents an important symptom that is seen in most patients. The diagnosis of PCD requires the presence of the characteristic clinical phenotypes and either: (1) specific ciliary ultrastructural defects identified by transmission electron microscopy in biopsy samples of respiratory epithelium; or (2) identification of mutation in one of the genes known to be associated with PCD. Nasal nitric oxide concentration is extremely low in PCD, and this could be useful for screening of the disease. At present, no fundamental therapies are available for PCD. Diagnosis in the early stages is important to prevent progression of bronchiectasis and deterioration of lung function by guidance for daily life, immunization, cessation of smoking and prompt therapy at the time of respiratory tract infection. Since PCD is inherited in an autosomal-recessive manner, genetic counseling is necessary after definite diagnosis.
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Affiliation(s)
- Kazuhiko Takeuchi
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Masako Kitano
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hajime Ishinaga
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masayoshi Kobayashi
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Satoru Ogawa
- Electron Microscopy Research Center, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kaname Nakatani
- Division of Personalized Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Sawako Masuda
- Department of Otorhinolaryngology, Mie National Hospital, Tsu, Japan
| | - Mizuho Nagao
- Institute for Clinical Research, Mie National Hospital, Tsu, Japan
| | - Takao Fujisawa
- Institute for Clinical Research, Mie National Hospital, Tsu, Japan
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16
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Czerny MS, Namin A, Gratton MA, Antisdel JL. Histopathological and clinical analysis of chronic rhinosinusitis by subtype. Int Forum Allergy Rhinol 2014; 4:463-9. [DOI: 10.1002/alr.21304] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 12/08/2013] [Accepted: 01/04/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Mary S. Czerny
- Department of Otolaryngology-Head and Neck Surgery; Saint Louis University School of Medicine; St. Louis MO
| | - Arya Namin
- Medical Degree Program; Saint Louis University School of Medicine; St. Louis MO
| | - Michael Anne Gratton
- Department of Otolaryngology-Head and Neck Surgery; Saint Louis University School of Medicine; St. Louis MO
| | - Jastin L. Antisdel
- Department of Otolaryngology-Head and Neck Surgery; Saint Louis University School of Medicine; St. Louis MO
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