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Blackley BH, Nett RJ, Cox-Ganser JM, Harvey RR, Virji MA. Eye and airway symptoms in hospital staff exposed to a product containing hydrogen peroxide, peracetic acid, and acetic acid. Am J Ind Med 2023; 66:655-669. [PMID: 37221450 PMCID: PMC10431326 DOI: 10.1002/ajim.23488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Sporicidal products containing hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are used widely in multiple industries, including healthcare. Despite widespread use in healthcare, few studies have assessed associations between exposures to HP, PAA, and AA, and work-related symptoms in these settings. METHODS In 2018, we performed a health and exposure assessment at a hospital where a sporicidal product consisting of HP, PAA, and AA, was used as the primary cleaner on hospital surfaces. We collected 56 personal and mobile air samples for HP, PAA, and AA on participants while they performed their regular cleaning duties; collected area samples for HP (n = 28), PAA (n = 28), and AA (n = 70) in multiple hospital locations where cleaning was performed; and administered a postshift survey to assess eye, skin, and upper and lower airway symptoms that occurred cross-shift or in the previous 4 weeks. RESULTS Full-shift exposure levels for HP (range: <3-559 ppb), PAA (range: <0.2-8 ppb), and AA (range: <5-915 ppb) were all below US occupational exposure limits. We observed positive associations (p < 0.05) between shift, departmental average, and departmental 95th percentile exposures to HP, PAA, and AA vapors, and work-related acute (cross-shift) and chronic (previous 4 weeks) eye, upper airway, and lower airway symptoms after adjusting for age, gender, smoking status, use of other cleaning products containing sensitizers and irritants, allergic status, and stress. CONCLUSIONS Our observations of work-related upper and lower airway symptoms among hospital workers exposed to vapors from a sporicidal product containing HP, PAA, and AA indicate a need for a combination of engineering, administrative, and PPE controls to reduce exposure. Additionally, alternative nonchemical disinfection technologies should be further investigated as a means to simultaneously reduce healthcare workers' exposure to disinfectants while also minimizing costly healthcare-acquired infections.
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Affiliation(s)
- Brie Hawley Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Randall J. Nett
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Fort Collins, Colorado, USA
| | - Jean M. Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Robert Reid Harvey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Mohammed Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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Maspero J, Adir Y, Al-Ahmad M, Celis-Preciado CA, Colodenco FD, Giavina-Bianchi P, Lababidi H, Ledanois O, Mahoub B, Perng DW, Vazquez JC, Yorgancioglu A. Type 2 inflammation in asthma and other airway diseases. ERJ Open Res 2022; 8:00576-2021. [PMID: 35923421 PMCID: PMC9339769 DOI: 10.1183/23120541.00576-2021] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/22/2022] [Indexed: 11/24/2022] Open
Abstract
Chronic inflammatory airway diseases, including asthma, chronic rhinosinusitis, eosinophilic COPD and allergic rhinitis are a global health concern. Despite the coexistence of these diseases and their common pathophysiology, they are often managed independently, resulting in poor asthma control, continued symptoms and poor quality of life. Understanding disease pathophysiology is important for best treatment practice, reduced disease burden and improved patient outcomes. The pathophysiology of type 2 inflammation is driven by both the innate immune system triggered by pollutants, viral or fungal infections involving type 2 innate lymphoid cells (ILC2) and the adaptive immune system, triggered by contact with an allergen involving type 2 T-helper (Th2) cells. Both ILC2 and Th2 cells produce the type-2 cytokines (interleukin (IL)-4, IL-5 and IL-13), each with several roles in the inflammation cascade. IL-4 and IL-13 cause B-cell class switching and IgE production, release of pro-inflammatory mediators, barrier disruption and tissue remodelling. In addition, IL-13 causes goblet-cell hyperplasia and mucus production. All three interleukins are involved in trafficking eosinophils to tissues, producing clinical symptoms characteristic of chronic inflammatory airway diseases. Asthma is a heterogenous disease; therefore, identification of biomarkers and early targeted treatment is critical for patients inadequately managed by inhaled corticosteroids and long-acting β-agonists alone. The Global Initiative for Asthma guidelines recommend add-on biological (anti IgE, IL-5/5R, IL-4R) treatments for those not responding to standard of care. Targeted therapies, including omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab and tezepelumab, were developed on current understanding of the pathophysiology of type 2 inflammation. These therapies offer hope for improved management of type 2 inflammatory airway diseases. Asthma is a heterogenous disease. Targeted therapies have been developed based on the pathophysiology of type 2 inflammation. These therapies offer hope for improved management of type 2 inflammatory airway diseases.https://bit.ly/3HCkrvQ
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Schmale IL, Yao WC, Luong AU, Citardi MJ. The role of CT and endoscopy in the evaluation of patients referred for intranasal Cryoablation. Am J Otolaryngol 2021; 42:102971. [PMID: 33667795 DOI: 10.1016/j.amjoto.2021.102971] [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] [Received: 02/01/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cryoablation (CA) of the posterior nasal nerves has garnered increasing interest as an office-based procedure for chronic rhinitis (CR). Standardized preoperative evaluation, specifically the role of computed tomography (CT) and nasal endoscopy, has yet to be defined. We report a series of patients who underwent CT and endoscopy as part of CR work-up in patients referred for CA. OBJECTIVE Highlight the importance of both nasal endoscopy and CT scan in the evaluation of CR given significant overlap of symptoms and common occurrence of related sinonasal conditions. METHODS Retrospective analysis of all patients referred to a single tertiary rhinology practice for CA was performed. RESULTS Fifteen patients were sent for CA by medical allergists. Five patients were deemed CA candidates, and 1 patient received only medical CR treatment. Four patients had evidence of incomplete prior sinus surgery and/or continued chronic rhinosinusitis on endoscopic exam. These 4 patients received a combination of medical and surgical management with either complete resolution or improvement in CR symptoms. In 3 patients, CT confirmed chronic rhinosinusitis that was not apparent on endoscopy, and received a combination of medical and surgical management with symptom improvement. In the last two patients, final diagnoses were nasal valve collapse and recurrent acute rhinosinusitis. CONCLUSIONS Referrals for CA are becoming more common and the optimal preoperative work up remains unclear. In this limited retrospective review, 67% of patients had diagnoses other than CR and thus were not deemed candidates for CA. Both CT and endoscopy are complementary to a detailed history and physical examination and can aid in CA candidate selection.
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Affiliation(s)
- Isaac L Schmale
- Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, NY, United States of America; Department of Otorhinolaryngology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States of America.
| | - William C Yao
- Department of Otorhinolaryngology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Amber U Luong
- Department of Otorhinolaryngology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Martin J Citardi
- Department of Otorhinolaryngology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States of America
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Di Berardino F, Zanetti D, Monzani D, Rossaro B, Cantarella G, Dejonckere P, Pignataro L. The Atopy Index Inventory: A Brief and Simple Tool to Identify Atopic Patients. ORL J Otorhinolaryngol Relat Spec 2020; 82:285-294. [PMID: 32791498 DOI: 10.1159/000508813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 05/14/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Atopy and ear, nose and throat (ENT) diseases are frequently associated; however, no clinical tool has been proposed so far to discriminate which patients could be atopic and therefore deserving of a further immunoallergological evaluation. OBJECTIVE The aim of this study was to assess and validate a set of dichotomous responses suitable for predicting the presence of atopy in adult patients. METHODS An 11-item questionnaire, i.e., the Atopy Index Inventory (AII), comprised of 4 questions regarding the clinical history for allergic disease and 7 questions evaluating the presence of the most frequent clinical signs affecting allergic patients, was developed and administered to 226 adult subjects (124 atopic subjects and 102 healthy, not atopic subjects). The atopic condition was proven by an immunoallergological evaluation according to the diagnostic criteria of the EAACI guidelines. Internal consistency and clinical validity were tested. RESULTS In healthy subjects, the first 4 variables of the AII returned a 100% correct response (all answered "no") and were defined as "decisive" responses. In the logistic regression analysis, when decisive items were negative, the atopic condition was confirmed when answering "yes" to at least 3 "probability" items (cut-off = 2.69). The difference in AII scores between allergic and healthy group was significant using the Mann-Whitney U test (p < 0.0001). The sensitivity and specificity of the AII were 0.97 and 0.91, respectively, with a true predictive value of 0.92 and a false predictive value of 0.97. The ROC curve showed an area of 0.94, with an OR of 0.88 (95% CI 0.87-0.97, p = 0.0001). The internal consistency as determined by the Cronbach α coefficient was 0.88. CONCLUSION The AII has been proven to be a brief, simple and sufficiently accurate tool for screening ENT patients in search of atopic individuals and to allow their clinical management.
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Affiliation(s)
- Federica Di Berardino
- Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, DISCCO (Department of Clinical Sciences and Community Health), University of Milan, Milan, Italy,
| | - Diego Zanetti
- Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, DISCCO (Department of Clinical Sciences and Community Health), University of Milan, Milan, Italy
| | - Daniele Monzani
- ENT Department, Policlinico di Modena University Hospital, Modena, Italy
| | - Bruno Rossaro
- DeFENS (Department of Food, Environmental, and Nutritional Sciences), University of Milan, Milan, Italy
| | - Giovanna Cantarella
- ENT Unit, Department of Biomedical, Surgical, and Dental Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, DISCCO (Department of Clinical Sciences and Community Health), University of Milan, Milan, Italy
| | | | - Lorenzo Pignataro
- ENT Unit, Department of Biomedical, Surgical, and Dental Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, DISCCO (Department of Clinical Sciences and Community Health), University of Milan, Milan, Italy
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Liu J, Jiang X, Li L, Liu H, Zhang X, Liu K, Yang C. Iloprost inhibits acute allergic nasal inflammation by GATA3 -ILC2 pathway in mice. Respir Physiol Neurobiol 2020; 276:103364. [DOI: 10.1016/j.resp.2019.103364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/26/2019] [Accepted: 12/29/2019] [Indexed: 12/26/2022]
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Harvey RR, Fechter-Leggett ED, Bailey RL, Edwards NT, Fedan KB, Virji MA, Nett RJ, Cox-Ganser JM, Cummings KJ. The Burden of Respiratory Abnormalities Among Workers at Coffee Roasting and Packaging Facilities. Front Public Health 2020; 8:5. [PMID: 32083049 PMCID: PMC7003510 DOI: 10.3389/fpubh.2020.00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/08/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Respiratory hazards in the coffee roasting and packaging industry can include asthmagens such as green coffee bean and other dust and alpha-diketones such as diacetyl and 2,3-pentanedione that can occur naturally from roasting coffee or artificially from addition of flavoring to coffee. We sought to describe the burden of respiratory abnormalities among workers at 17 coffee roasting and packaging facilities. Methods: We completed medical surveys at 17 coffee roasting and packaging facilities that included interviewer-administered questionnaires and pulmonary function testing. We summarized work-related symptoms, diagnoses, and spirometry testing results among all participants. We compared health outcomes between participants who worked near flavoring and who did not. Results: Participants most commonly reported nose and eye symptoms, and wheeze, with a work-related pattern for some. Symptoms and pulmonary function tests were consistent with work-related asthma in some participants. About 5% of workers had abnormal spirometry and most improved after bronchodilator. Health outcomes were similar between employees who worked near flavoring and who did not, except employees who worked near flavoring reported more chronic bronchitis and ever receiving a diagnosis of asthma than those who did not work near flavoring. Conclusion: The symptoms and patterns likely represent overlapping health effects of different respiratory hazards, including green coffee bean and other dust that can contribute to work-related asthma, and diacetyl and 2,3-pentanedione that can contribute to obliterative bronchiolitis. Healthcare providers and occupational health and safety practitioners should be aware that workers at coffee roasting and packaging facilities are potentially at risk for occupational lung diseases.
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Affiliation(s)
- R. Reid Harvey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
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Xue JM, Ma F, An YF, Suo LM, Geng XR, Song YN, Mo LH, Luo XQ, Zhang XW, Liu DB, Zhao CQ, Yang PC. Probiotic extracts ameliorate nasal allergy by inducing interleukin-35-producing dendritic cells in mice. Int Forum Allergy Rhinol 2019; 9:1289-1296. [PMID: 31623025 DOI: 10.1002/alr.22438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/22/2019] [Accepted: 09/03/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The therapeutic efficacy of allergic rhinitis (AR) needs to be improved. Probiotics have immunoregulatory functions. In this study we evaluated the effects of protein extracts of probiotics in the amelioration of AR. METHODS Extracts of Bifidobacterium infantis (EBI) were prepared by lysing the live probiotics. AR mice were developed to be used to evaluate the therapeutic efficacy of EBI. RESULTS The results show that EBI induced interleukin (IL)-10-producing dendritic cells (DCs) via increasing IL-35 and signal transducer and activator of transcription 3 (STAT3) phosphorylation. IL-10-expressing DCs induced IL-10-producing B cells (B10 cells), with the latter showing immunosuppressive functions. After challenge with specific antigens, AR mice showed sneezing, nasal itch, and increases in serum-specific immunoglobulin E (IgE) and mouse mast cell protease-1; higher levels of T helper 2 (Th2) cytokines (IL-4, 67.17 ± 10.66; IL-5, 62.83 ± 9.70; IL-13, 51.00 ± 6.69, before treatment) in nasal mucosal protein extracts, which were significantly suppressed (IL-4, 27.00 ± 6.66; IL-5, 23.86 ± 4.53; IL-13, 25.67 ± 4.93, after treatment (p < 0.001) by administration with EBI nasal drops. CONCLUSION EBI can suppress AR via inducing B10 cells. Thus, after carrying out required preclinical experiments and tests, EBI has the translational potential to be used in the treatment of AR and other allergic diseases.
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Affiliation(s)
- Jin-Mei Xue
- Department of Otolaryngology, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Fei Ma
- Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen, China.,Department of Otolaryngology, Head & Neck Surgery, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yun-Fang An
- Department of Otolaryngology, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Li-Min Suo
- Department of Otolaryngology, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Xiao-Rui Geng
- Department of Otolaryngology, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Yan-Nan Song
- Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen, China
| | - Li-Hua Mo
- Department of Pediatrics, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xiang-Qian Luo
- Department of Pediatrics, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xiao-Wen Zhang
- Department of Otolaryngology, Head & Neck Surgery, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Da-Bo Liu
- Department of Pediatrics, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Chang-Qing Zhao
- Department of Otolaryngology, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Ping-Chang Yang
- Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen, China
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Youssef AM, Awad OGAN, Taha M. Pulmonary Function of Patients with Chronic Rhinosinusitis and the Impact of Endoscopic Sinus Surgery. OTO Open 2017; 1:2473974X17738759. [PMID: 30480195 PMCID: PMC6239150 DOI: 10.1177/2473974x17738759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/02/2017] [Accepted: 10/04/2017] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The aim of this study was to compare pulmonary function tests (PFTs) among control subjects and patients with chronic rhinosinusitis (CRS) and to investigate the outcomes of endoscopic sinus surgery (ESS) on PFTs among patients with CRS. STUDY DESIGN Prospective study conducted from June 2015 to June 2016. SETTING Tertiary referral hospital. SUBJECTS AND METHODS The study is based on 2 groups: adult control subjects (group 1, n = 25) and adult patients with medically resistant CRS (group 2, n = 25). PFTs were used to compare the lower airway condition between the groups. Another comparison in PFTs was made among patients with CRS at 1 week preoperatively and 1 month postoperatively to evaluate the effectiveness of ESS. RESULTS In group 1, all subjects had an FEV1/FVC ratio ≥80% (forced expiratory volume in 1 second / forced vital capacity) with a mean of 0.84 ± 0.07, as compared with group 2, from 61% to 70% for 5 (20%) patients, 71% to 79% for 10 (40%), and ≥80% for 10 (40%). FEV1/FVC was significantly lower in group 2 than group 1 (P = .04). At 1 month postoperatively, the FEV1/FVC values of group 2 was from 61% to 70% for 2 (8%) patients, 71% to 79% for 13 (52%), and ≥80% for 10 (40%). The mean FEV1/FVC was 0.9 ± 0.50, and these values were significantly higher (P = .02) when compared with preoperative values. CONCLUSION This study provides objective evidence that patients with CRS may have nonmanifest lower airway affection when compared with control subjects and that ESS is efficacious in the improvement of such affection.
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Affiliation(s)
- Ahmed M. Youssef
- Otolaryngology–Head and Neck Department,
Minia University, Minia, Egypt
| | | | - Mohamed Taha
- Chest Department, Minia University,
Minia, Egypt
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Chen ZY, Zhou SH, Zhou QF, Tang HB. Inflammation and airway remodeling of the lung in guinea pigs with allergic rhinitis. Exp Ther Med 2017; 14:3485-3490. [PMID: 29042937 PMCID: PMC5639300 DOI: 10.3892/etm.2017.4937] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 06/01/2017] [Indexed: 12/11/2022] Open
Abstract
Allergic rhinitis (AR) and asthma belong to the category of type I allergic diseases, whose pathological features are airway remodeling of the lung and allergic inflammation. The aim of the present study was to evaluate inflammation and remodeling of lung tissue in a guinea pig model of AR in order to confirm consistent pathological changes of upper and lower airways in AR. Male guinea pigs were randomly divided into an experimental and a control group (n=10 in each). The AR model was established by sensitization through intraperitoneal injection of ovalbumin for three weeks and bilateral nasal local excitation for twelve weeks. All tissues of nasal mucosa and lung were subjected to hematoxylin and eosin as well as toluidine blue staining, and characteristics of remodeling of lung tissue, including thickness of bronchial wall, epithelial mucosa and smooth muscle were histologically determined. Collagen deposition in lung tissue was observed by Masson's trichrome stain. Severe paroxysmal nose scratching action, frequent sneezing, visible outflow of secretion from the anterior naris and frequent nose friction were observed in the AR model group within 30 min after local excitation. The total symptom scores were significantly increased in the AR model group compared with those in the control group. Obvious inflammatory cell infiltration was observed in the AR model group. Compared with those in the control group, the numbers of eosinophils and mast cells in nasal mucosa and lung tissue were significantly increased. Obvious airway remodeling of the lung was observed in the AR model group. Compared with those in the control group, bronchial wall thickness, epithelial layer thickness and smooth muscle thickness in the airways were significantly increased in the AR model group. Increased collagen deposition was found in the AR model group compared with that in the control group. The results of the present study revealed that inflammation and airway remodeling of lungs arose in guinea pigs with AR, suggesting that pathological changes of upper and lower airways are consistent in this AR model.
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Affiliation(s)
- Zu-Yao Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Shou-Hong Zhou
- Institute of Neuroscience, School of Medicine, The First Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Qiao-Feng Zhou
- Department of Pediatrics, The First Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Hong-Bo Tang
- Department of Otorhinolaryngology, The First Affiliated Hospital, University of South China, Hengyang, Hunan 421001, P.R. China
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