Ocular immune privilege and retinal pigment epithelial cells

The ocular tissue microenvironment is immune-privileged and uses multiple immunosuppressive mechanisms to prevent the induction of inflammation. The retinal pigment epithelium plays an essential role in ocular immune privilege. In addition to serving as a blood barrier separating the fenestrated choriocapillaris from the retina, the retinal pigment epithelium is a source of immunosuppressive cytokines and membrane-bound negative regulators that modulate the activity of immune cells within the retina. This article reviews the current understanding of how retinal pigment epithelium cells mediate immune regulation, focusing on the changes under pathologic conditions.

Characterization of the Notch pathway in nasal polyps of patients with chronic rhinosinusitis: A pilot study

Chronic rhinosinusitis with nasal polyps is a widespread pathology characterized by persistent inflammation of nasal and paranasal mucosa. Although it represents one of the most frequent diseases of the nasal cavities, its etiology is still not completely elucidated. There is evidence suggesting that the Notch signaling, a highly conserved intercellular pathway known to regulate many cellular processes, including inflammation, is implicated in nasal polyps formation. The purpose of this study was to investigate the expression of genes of the Notch pathway in nasal polyps from patients with chronic rhinosinusitis. Nasal polyps and adjacent mucosa tissue were obtained from 10 patients. RNA was analyzed by quantitative reverse transcriptase-polymerase chain reaction for the expression level of (1) Notch pathway components such as receptors (NOTCH1-4), ligands (DLL4, JAGGED-1), and target genes (HEY1, 2, and HES1) and (2) genes providing information on the pathogenesis of polyposis (C-MYC and SCGB1A1) and on eosinophils content (CCL26, IL5, and SAA2). We report a Notch-driven gene expression pattern in nasal polyps which correlates with the expression of genes highly expressed in eosinophils, whose presence is an important parameter to define the pathophysiologic diversity characterizing nasal polyps. Taken together, our results suggest a role for Notch signaling in the pathophysiology of polyposis. Further studies are needed to elucidate the role of Notch in nasal polyps formation and to establish whether it could represent a novel therapeutic target for this pathology.

Treatment and evaluation of recurrence for antrochoanal polyps by endoscopic large middle meatal antrostomy, clinical case series of 25 patients

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The endoscopic approach is considered safe and effective procedure.

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Endoscopic large middle meatal antrostomy has a low recurrence rate in antrochoanal polyps.

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The antral portion of ACP should be removed, together with the periostium on the point of origin.

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The development of endoscopic naso-sinusal instrumentation allows the best control of the site origin of the ACP.

Introduction

The Endoscopic approach for complete removal of antrochoanal polyp is considered a safe and effective procedure with the best control of the attachments of antrochoanal polyps.

The mains of our study are to review the clinical features and evaluate the recurrence in the patients affected by antrochoanal polyps (ACPs) and surgically treated by endoscopic middle meatal antrostomy.

Methods

The present research is a retrospective study. it includes the clinical data of subjects affected by ACPs, and referred to ENT Department, Face and Neck Surgery, Hospital 20 August 1953, between January 2016 and January 2019.

Results

All patients have been treated surgically with endoscopic middle meatal antrostomy under general anesthesia. Recurrence occurred in 3 cases (12%), in these three recurrent cases, the site of attachment originated from the lateral wall.

Conclusion

FESS was the first-choice treatment for APCs in the present series; our recurrence rate was encouraged for the practice of the endonasal endoscopic approach. A focus on the detection of the exact origin of the polyp and the resection of the periostium on the point of attachment considered the key to prevent recurrence.

Clinical features and management of antrochoanal polyps in children: Cues from a clinical series of 58 patients

OBJECTIVE

To review the clinical features of pediatric patients affected by antrochoanal polyps (ACPs) and surgically treated at three University settings.

METHODS

Retrospective study. The present research includes the clinical data of subjects affected by ACPs, aged <18 years and referred to three ENT Departments, between January 1st 2003 and September 30th 2016. All patients underwent nasal endoscopy and sinonasal imaging; all subjects have been treated surgically.

RESULTS

Fifty-eight patients underwent functional endoscopic sinus surgery (FESS) for ACPs removal, under general anesthesia. There were no major intraoperative complications. Recurrence occurred in 12 cases (20.5%).

CONCLUSIONS

FESS was the first-choice treatment for APCs in the present series; our recurrence rate was similar to that of other reports available in literature. Recurrences of ACPs in children still represent a clinical challenge; it is likely that an improved comprehension of ACPs biology could help in better understanding the pathophysiology of this disease.

Is Nasal Polyposis Related to Levels of Serum Vitamin D and Vitamin D Receptor Gene Expression?

BACKGROUND Nasal polyposis (NP) is the most frequent cause of nasal masses. Despite considerable research on the subject, its etiology has not been fully elucidated, and effective treatment methods have not been developed. Some etiological factors causing low or high expression of genes in genetically predisposed individuals may play a role in the pathogenesis of the disease. The purpose of this study was to assess the relation between levels of vitamin D receptor (VDR) gene expression and serum vitamin D with NP. MATERIAL AND METHODS The study included 46 subjects with NP (NP group) and 40 volunteers (control group). Nasal polyp tissue samples were taken from the NP group and nasal mucosa samples were taken from the control group. Levels of VDR gene expression in the tissue samples were assessed using the real-time polymerase chain reaction (RT-PCR) method. RESULTS Mean serum 25(OH)D levels were 13.38±14.08 ng/ml in the NP group and 10.57±6.44 ng/ml in the control group (p=0.249). VDR gene expression was present in 17.5% of the NP group and 3.3% of the control group, and the difference between the 2 groups was statistically significant (likelihood ratio χ²=3.887; p=0.049). CONCLUSIONS This is the first study to assess levels of VDR gene expression in subjects with NP. Our results suggest that VDR gene expression may be associated with the pathogenesis or progression of NP.