The changes of clinical and histological characteristics of chronic rhinosinusitis in 18 years: Was there an inflammatory pattern shift in southern China?

Background

Nowadays, the heterogeneity of chronic rhinosinusitis (CRS) has attracted extensive attention. The histological patterns and clinical characteristics may vary greatly in different areas and among different groups of people. Prior studies found a shift from the neutrophilic inflammatory pattern to the eosinophilic inflammatory pattern in Asian cities. This study set out with the aim of investigating the changes that have occurred in the past 18 years of southern China and exploring the causes.

Methods

Tissues, clinical, and demographic characteristics were obtained from 473 patients (91 in 2000–2001, 170 in 2010–2011, 212 in 2017–2018) who satisfied the criteria of diffuse (bilateral) chronic rhinosinusitis. The clinical characteristics, including the previous history of allergic rhinitis and asthma, and the major symptoms of rhinosinusitis, were collected. Formalin-fixed nasal tissue was obtained from each patient for calculating inflammatory cells. We also performed immunohistochemistry to evaluate the expression levels of eosinophilic cationic protein (ECP), IgE, myeloperoxidase (MPO), and other Type 1, Type 2, and Type 3 related inflammatory cytokines.

Results

The comorbidity of asthma and atopic disease was higher in 2017–2018 compared to 2000–2001. The histological characteristics revealed a significant increase in tissue eosinophils and decrease in neutrophils in 2017–2018 as compared with 2000–2001. Meanwhile, the proportion of eosinophilic CRS (eCRS) increased significantly from 2000 to 2001 to 2017–2018 (P = 0.03). The tissue eosinophil increase was higher in overweight patients (Body Mass Index, BMI≥24) as compared with non-overweight. There was an increasing trend of ECP, IL-13 and IL-17. Besides, IFN-γ and TNF-α decreased.

Conclusions

There was an eosinophilic shift of diffuse rhinosinusitis inflammatory pattern in southern China over the last 18 years. The proportion of eCRS and difficult-to-treat rhinosinusitis has steadily increased, which is associated with the increase of Type 2, Type 3 cytokines and the decrease of Type 1 cytokines. This study also provided firstly evidence of a strong relationship between overweight and eosinophil shift in the southern Chinese population.

[New system combining Hyams grading system and modified Kadish stage to evaluate the progress of esthesioneuroblastoma]

Objective:Esthesioneuroblastoma(ENB) is a sinonasal rare tumor, and the assessment on the prognosis have not been used with on consensus, our study aims to set an accuracy indicator to predict the outcomes of ENB.Method:A retrospective review was performed on 31 ENB patients. We collected 31 patients with ENB and reviewed the clinical data and pathological slides; modified Kadish stages were evaluated by otolaryngologist and imaging specialist; Hyams grading system were confirmed by two pathologists, who reviewed and paid attention to the pathological characteristics of Hyams grading system. Finally, the relation among the clinical data, pathological features and clinical outcome of these 31 ENB were analyzed by Kaplan-Meier method.Result: The Hyams grading system and modified Kadish stage were considered together seemed to evaluate the prognosis of ENB more accurately, when the scores over 6 points, the patients had the poor prognosis with the mean median survival months of 24.67±32.22, compared with the scores under 6 and the final scores reached at 4, 5, 6, 7, 8, the tumor metastasis rates were 14.3%, 16.7%, 33.3%, 50.0%, 100.0% respectively.Conclusion:Taking the Hyams grading system and modified Kadish stage into consideration, which may evaluate the prognosis of ENB more accurately.

[Study on the relationship between 11β-hydroxysteroid dehydrogenase and glucocorticoid response in nasal polyps]

Objective: To investigate the expression of 11β-hydroxysteroid dehydrogenase (11β-HSD) in polyps of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and its correlation with glucocorticoid sensitivity. Methods: The prospective study method was applied. Forty-three adult CRSwNP patients from Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University between April 2016 and June 2017 were enrolled in this study. There were 19 males and 24 females with the age of (37.44±7.42) years old. The endoscopic scores by nasal Polyps Grading System before and after one-week prednisone treatment (0.5 mg/(kg·d)) were evaluated. The response of glucocorticoid by the total endoscopic scores was estimated. According to the patient's reduced nasal polyp endoscopic score, patients were devided into nasal polyps insensitive to glucocorticoids treatment group (insensitive group) and nasal polyp sensitive to glucocorticoids treatment group (sensitive group). The expression of 11β-HSD1, 11β-HSD2 in nasal polyps were measured by Real-time PCR (RT-PCR), Western Blot and immunohistochemisty. According to the clinical data, the Logistic regression models and receiver operation characteristics (ROC) curves were used to explore the predictor for glucocorticoid response in CRSwNP. Results: The expression of 11β-HSD1 and 11β-HSD1/11β-HSD2 was higher in sensitive group than that of insensitive group, while the expression of 11β-HSD2 was lower (rank average was 26.08 vs 16.33, 27.24 vs 14.72, 18.66 vs 26.64, Z value was -2.511, 0.323, -2.059, respectively, all P<0.05). The endoscopic scores in CRSwNP group declined whereas the expression of 11β-HSD1/11β-HSD2 increased (r=0.528, P=0.001), while the cutoff value of the ratio of 11β-HSD1/11β-HSD2 was 2.290 (sensitivity was 79.17%, specificity was 88.89%). Conclusions: There is a positive correlation between the response of glucocorticoid and the ratio of 11β-HSD1/11β-HSD2, which could be used as a marker in predicting the level of tissue response to glucocorticoid therapy in CRSwNP.

[Clinical features, diagnosis and treatment of silent sinus syndrome]

Objective: To explore the clinical features, diagnostic methods and therapeutic strategy of silent sinus syndrome (SSS). Methods: A retrospective study was made on eight SSS patients treated during 2013-2016 in Longgang ENT Hospital and Otorhinolaryngology Hospital of the First Affiliated Hospital of SUN Yat-sen University. The following clinical data, including demographic data, symptoms, history of trauma and surgery, signs, imaging examination, endoscopic surgery and postoperative outcomes, were analyzed to summarize the diagnosis and treatment experiences. Results: Eight SSS patients showed the following clinical features: the proportions of both sexes and sinus sides were 4 to 4; seven cases (7/8) were adult, with an average of (48.1±11.8)y; seven cases (7/8) had long history of trauma or surgery, with an average of (17.9±10.5)y; seven cases (7/8) cannot recall the exact course of SSS; six cases (6/8) had no nasal symptoms; eight cases (8/8) had unilateral ocular discomforts; eight cases (8/8) had signs of unilateral enophthalmos (2-5 mm), accompanied with hypoglobus; and by CT and MRI scanning, eight cases (8/8) showed the unilateral maxillary sinus outlet obstruction, sinus full opacification, sinus wall bony rarefaction, sinus wall contraction, sinus volume loss, and the ipsilateral orbital floor bowing descent and orbital volume increase. After treated by endoscopic sinus surgery and followed-up for one year, four cases were cured, and the other four improved; no intra- or post-operative complications occurred; and no individual need a two-stage orbital plastic reconstruction. Conclusions: SSS often develops in the unilateral maxillary sinus of adult patient with long history of trauma or surgery, but the nasal symptoms and signs are silent. Diagnostic for SSS depends on characteristic ocular sign and sinus CT imaging. Endoscopic sinus surgery helps to improve ocular and nasal signs and promote orbital self-reconstruction.

The ratio of 11β-hydroxysteroid dehydrogenase 1/11β-hydroxysteroid dehydrogenase 2 predicts glucocorticoid response in nasal polyps

BACKGROUND

Glucocorticoids are the first-line medical treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), whose local metabolism is catalyzed by 11β-HSD1 and 11β-HSD2. This study investigates the role of 11β-HSD1 and 11β-HSD2 on the glucocorticoid response of CRSwNP patients and the pathogenic mechanism of these polyps.

METHODS

Forty-three adult CRSwNP patients were enrolled in this study. We evaluated the endoscopic scores by a nasal polyp grading system before and after treatment. We estimated the response to glucocorticoids by the total endoscopic scores. The logistic regression models and inflammatory characteristic curves were conducted to explore the prediction of the response to glucocorticoid in CRSwNP. The expression of 11β-HSD1 and 11β-HSD2 on human sinonasal epithelial cells (HSECS) was measured under the stimulation of toll-like receptor agonists and dexamethasone.

RESULTS

The endoscopic scores in the CRSwNP group declined, the expression of 11β-HSD1/11β-HSD2 increased (r = 0.5276, P = 0.0011), and the cutoff value of the ratio of 11β-HSD1/11β-HSD2 was 0.4654 (sensitivity 79.17%, specificity 88.89%). Dexamethasone induced a decrease in the ratio of 11β-HSD1/11β-HSD2 (P = 0.049) by the stimulation of PGN-BS.

CONCLUSION

We found a strong correlation between the response to glucocorticoids and the ratio of 11β-HSD1/11β-HSD2, which could be used as a marker in predicting the level of tissue response to glucocorticoid therapy in CRSwNP. In addition, PGN-BS could also be a therapeutic target, as it is the negative factor that will decrease the sensitivity of glucocorticoids by reducing the ratio of 11β-HSD1/11β-HSD2.

WDPCP regulates the ciliogenesis of human sinonasal epithelial cells in chronic rhinosinusitis

Damage to the mucociliary clearance system is a typical change in the pathogenesis in chronic rhinosinusitis. However, the mechanisms underlying cilia loss remain unclear. WDPCP is a key protein essential for ciliogenesis, and is also an effector of the planar cell polarity signaling system. In this study, we sought to determine the role of WDPCP in cilia loss in patients with chronic rhinosinusitis. We demonstrated the expression of WDPCP in human sinonasal epithelium from patients with chronic rhinosinusitis and control subjects. We also used air-liquid interface to culture primary human sinonasal epithelial cells in-vitro model and to investigate WDPCP function. We then explored links between rhinosinusitis, WDPCP and inflammation. Accompanied with cilia loss, expression of WDPCP in human sinonasal epithelium from patients with chronic rhinosinusitis was decreased significantly compared with control subjects. In vitro study, we found that WDPCP level increased at first, and then decreased. Inhibiting WDPCP expression could lead to the poor quantity and length of cilia with reduced expression of Septin7. Also, Th1 type inflammatory mediators could decrease the expression of WDPCP. In conclusion, inflammatory cytokines cause reduced WDPCP expression, which contributes to impaired ciliogenesis in human rhinosinusitis.

[Expression of heme oxygenase-1 in nasal polyps and regulation by glucocorticoid]

OBJECTIVE

To evaluate the expression and possible modulation of heme oxygenase-1 (HO-1) in nasal polyps of patients with chronic rhinosinusitis with nasal polyps (CRSwNP).

METHODS

Nasal polyps and uncinate process tissues were collected from 25 CRSwNP patients and 19 healthy controls with nasal septal deviation. HO-1 expression was examined using qRT-PCR, immunohistochemistric staining and Western blot analysis. Moreover, additional uncinate process mucosal samples of 15 healthy controls with nasal septal deviation were harvested for nasal explant culture experiments. HO-1 expression was measured in cultured nasal explant in response to specific inflammatory and glucocorticoid stimulation. SPSS 20.0 software was used to analyze the data.

RESULTS

The mRNA and protein expression of HO-1 was significantly increased in polyp tissues, 1.220±0.397 in mRNA and 1.409±0.701 in protein, compared with healthy controls 0.464±0.318 in mRNA and 0.017±0.1147 in protein (U=22.00 in mRNA and U=1.00 in protein, both P< 0.05). The immunohistochemical results showed that HO-1 was mainly distributed in the epithelial layer, submucosal glands and inflammatory cells in nasal tissues. Nasal explant culture experiments demonstrated that HO-1 mRNA was upregulated by IL-17A. The HO-1 mRNA level before the stimulation was 1.000, and 17.264±4.275 after the stimulation of 1 ng/ml IL-17A (U=0, P<0.05), 19.128±4.605 after the stimulation of 10 ng/ml IL-17A (U=0, P<0.05), but was significantly suppressed after stimulation with glucocorticoids (dexamethasone, DEX). The mRNA level after the glucocorticoids stimulation was 0.370±0.101 (U=0, P<0.05) and 0.316±0.167 (U=0, P<0.05) respectively. Furthermore, the HO-1 mRNA was inhibited by TGF-β1, the mRNA level was 0.217±0.322 (U=0, P<0.05), 0.070±0.070 (U=0, P<0.05), respectively.

CONCLUSION

Increased HO-1 expression may play a role in the pathogenesis of CRSwNP, which may be considered as the therapeutic target.

Expression of leukotriene and its receptors in eosinophilic chronic rhinosinusitis with nasal polyps

BACKGROUND

Cysteinyl leukotriene (LT) has been proposed in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). This study sought to examine the expression of the LT receptor (LTR) in CRSwNP patients and evaluate the potential role of LTR antagonist (LTRA) in the management of eosinophilic CRSwNP (ECRS) patients.

METHODS

Nasal polyps and uncinate process tissues were collected from 18 ECRS patients, 13 non-eosinophilic CRSwNP (non-ECRS) patients, and 16 control subjects. The messenger RNA (mRNA) and protein expression of LTR (cysteinyl leukotriene receptor 1 [CysLT1R] and cysteinyl leukotriene receptor 2 [CysLT2R]) was examined using quantitative reverse-transcription polymerase chain reaction (qRT-PCR), immunohistochemistry, and Western blot analysis. Moreover, the effects of LTRA and steroids on total nasal symptom scores (TNSS) of uncontrolled ECRS patients were evaluated.

RESULTS

The mRNA and protein expression of CysLT1R and CysLT2R was significantly increased in polyp tissues compared with healthy controls (p < 0.05). Compared with the non-ECRS subset, the ECRS subset showed significantly increased expression of CysLT1R and CysLT2R, as well as leukotriene C4 (LTC4) and leukotriene D4 (LTC4) levels (p < 0.05). Moreover, combined LTRA and steroids significantly decreased TNSS more than steroids alone in uncontrolled ECRS patients (p < 0.01).

CONCLUSION

Our findings indicate that LTR was differentially expressed between ECRS and non-ECRS patients, and that LTRA may be used as an additional therapy for ECRS patients.

[A national investigation on the application of Chinese guideline for the diagnosis and treatment of chronic rhinosinusitis]

OBJECTIVE

To investigate the application of Chinese guideline for the diagnosis and treatment of chronic rhinosinusitis (2008, Nanchang) on a national scale.

METHODS

The contents of the guideline and its relevant applied indicators were designed into an initial questionnaire and, after a pre-survey, revised into a formal questionnaire. Then a stratified sampling was selected out of otolaryngology practitioners in the different level hospitals across the country. After a uniform training, the investigators were sent to these different hospitals to conduct questionnaire survey by face to face interview with otolaryngology respondents. Based on the summarized data, statistical analyses on the awareness and practice status of the guideline, together with their influencing factors, were made. SPSS 16.0 software was used to analyze the data.

RESULTS

Issuing and withdrawing questionnaires were performed from December 2012 to June 2013 and 1 240 respondents in 350 hospitals from 30 different provinces, municipalities or autonomous regions were effectively investigated. An average awareness and practice rate of 48.7% and 40.8% upon the guideline was acquired, respectively. There was a significant correlation (r = 0.280, P = 0.000) between the two indicators. With linear regression, county-level hospitals, junior practitioners, non-rhino professionals were the risk factors of poor guideline adherence. In addition, respondents form western region showed lower awareness and practice rate than that of ones from central and eastern region.

CONCLUSION

The adherence on Chinese guideline for the diagnosis and treatment of chronic rhinosinusitis is nationally low, so popularization of activities should be urgently strengthened, especially in focus areas, focus hospitals, and focus groups.

A hospital-based survey on the prevalence of bronchial asthma in patients with allergic rhinitis in southern China

BACKGROUND

The prevalence of bronchial asthma (BA) and the underlying risk factors in patients with allergic rhinitis (AR) in China are largely unknown. Thus, this study is designed to assess the BA comorbidity in AR patients in two cities (Guangzhou and Zhuhai) of southern China and to determine the risk factors of BA in these AR patients.

METHODS

We performed a cross-sectional, hospital-based survey in two modernized cities in southern China. The BA prevalence was evaluated in 1931 AR patients. Participants were asked to complete a questionnaire containing specific items for AR and BA. A logistic regression analysis was used to assess the risk factors of BA comorbidity in AR patients.

RESULTS

The prevalence of concomitant BA in AR patients is 5.33% (103/1931). Most of the participants (98.4%) were sensitized to more than one allergen, and the most common sensitization was to house-dust mites. The strongest risk factor of BA determined by a multiple logistic regression analysis was a duration of AR of >5 years (adjusted odds ratio [OR], 8.67; 95% confidence interval [CI], 3.74-20.06), followed by smoking (adjusted OR, 7.21; 95% CI, 1.86-8.23) and self-medication with antibiotics (adjusted OR, 6.35; 95% CI, 3.43-11.78).

CONCLUSION

Our findings suggested the risk factors of concomitant BA in AR patients may be helpful to establish preventive strategies.

A modified surgical procedure for endoscopic optic nerve decompression for the treatment of traumatic optic neuropathy

Background:

Although the endoscopic anterior-to-posterior technique offers many advantages, the long-term effects of the iatrogenic trauma (removal of the uncinate process and anterior ethmoidal sinus) resulting from the complete ethmoidectomy procedure used to gain full access to the optic nerve canal is unknown, and sequelae such as nasal synechia and sinusitis should not be ignored.

Aims:

The aim of our study is to develop a less invasive procedure for endoscopic optic nerve decompression.

Materials and Methods:

We proposed a modified trans-sphenoidal surgical procedure for endoscopic optic nerve decompression in five patients with traumatic optic neuropathy (TON), all with high sphenoidal pneumatisation and without Onodi cellulae.

Results:

After performing a direct sphenoidotomy through the natural ostium of the sphenoid sinus rather than a complete ethmo-sphnoidectomy, we found that the modified approach provided adequate access to the optic nerve canal and the apex using a 45° angled endoscope. Successful decompression of the canal optic nerve was performed trans-sphenoidally in all five TON patients using an angled endoscope. No surgical complications occurred, and none of the patients suffered from anterior ethmoidal sinus or skull base damage.

Conclusions:

The modified trans-sphenoidal approach is a feasible, safe, effective, and minimally invasive approach for TON patients with high sphenoidal pneumatisation and without supersphenoid-ethmoid cellulae.

[Expression and regulation of tight junction protein Occludin in nasal polyps]

OBJECTIVE

To evaluate the possible role of tight junction protein Occludin in nasal polyps.

METHODS

The expression of Claudin-1, Occludin and ZO-1 in nasal polyps (n = 20) and healthy uncinate mucosa (n = 15) were examined using immunohistochemical staining, real-time quantitative polymerase chain reaction (PCR) and Western blot analysis. The regulatory effects of proinflammatory cytokines (IFN-γ, IL-13, IL-17, TGF-β, TGF-α) on the expression of Occludin in cultured human nasal epithelial cells were investigated.

RESULTS

The immunohistochemical results showed that Claudin-1, Occludin and ZO-1 were detected both in the nasal polyp group and the control group. The expression sites were the cell membrane and cytoplasm of nasal mucosa epithelial cells. The mean optical density of Claudin-1, Occludin and ZO-1 were 0.187 ± 0.076,0.172 ± 0.109 and 0.098 ± 0.035 respectively in the nasal polyp group and were significantly lower than those in the control group (0.312 ± 0.101, 0.220 ± 0.069 and 0.233 ± 0.093 respectively), the differences were significant (t = 9.345, t = 3.301, t = 13.323, all P < 0.01).RT-PCR results showed that the relative expression of Occludin mRNA was 0.000 117 ± 0.000 035 in the nasal polyp group and was significantly lower than that in the control group(0.000 464 ± 0.000 134), and the difference was significant (Z = -5.0, P < 0.01) . There was no statistically significant difference in the relative expression of Claudin-1 and ZO-1 mRNA between the nasal polyp group and the control group (P > 0.05) . After the cultured human nasal epithelial cells were stimulated by IL-13, IL-17, IFN-γ and other proinflammatory cytokines, the relative expression of Occludin mRNA was 0.631 ± 0.039, 0.581 ± 0.029 and 0.648 ± 0.040, respectively. Compared with the unstimulated control group, the differences were statistically significant (t = 16.299, 24.669 and 14.995 respectively, all P < 0.05).Western blot analyse showed that the relative grayscale in the above proinflammatory cytokines stimulation groups was 0.650 ± 0.061,0.482 ± 0.106 and 0.536 ± 0.109, respectively. Compared with the unstimulated control group, the differences were statistically significant (t = 9.880, 8.442 and 7.310 respectively, all P < 0.05).

CONCLUSIONS

The reduced expression of Occludin might be involved in the pathogenesis of nasal polyps.

Endoscopic optic nerve decompression for patients with traumatic optic neuropathy: is nerve sheath incision necessary?

OBJECTIVE

To evaluate the necessity of nerve sheath incision for the treatment of patients with traumatic optic neuropathy (TON) during endoscopic optic nerve decompression.

METHODS

Seventy-four TON patients were enrolled and subjected to endoscopic optic nerve decompression. In 31 TON patients (group A), osseous decompression and nerve sheath incision were performed, and in 43 TON patients (group B), osseous decompression alone was carried out. Visual acuity was evaluated postoperatively.

RESULTS

After surgery, visual acuity was improved in 47 of 74 patients, with a total effectiveness ratio of 63.5%. The total ratio of improvement in groups A and B was 61.2 and 65.1%, respectively, and no significant difference was observed (p > 0.05). As to the patients with residual vision preoperatively, the ratio of improvement in groups A and B was 64.2 and 71.4%, respectively (p > 0.05), not favoring nerve sheath incision during endoscopic optic nerve decompression.

CONCLUSION

Our preliminary results suggest that during endoscopic optic nerve decompression for the treatment of TON patients, nerve sheath incision is not obligatory for the improvement of visual acuity.

Clinical characteristics and surrogate markers of eosinophilic chronic rhinosinusitis in Southern China

The surrogate markers for subclassifying eosinophilic chronic rhinosinusitis (ECRS) and non-ECRS remain elusive. We herein performed a cross-sectional study to assess the clinical implication of clinical symptoms, CT findings, blood eosinophil (EOS) examination based on histological examination of tissue eosinophilia in 105 adult CRS patients (including 72 with nasal polyps and 33 without nasal polyps) in southern China. We found the mean score of smell loss was significantly higher in ECRS subgroup than those in non-ECRS subgroup (p < 0.05), whereas the average ethmoid osteitis index in non-ECRS subgroup was significantly higher than that in ECRS subgroup (p < 0.05). Moreover, we found both the mean blood EOS number and ratio were significantly higher in ECRS subgroup than those in non-ECRS subgroup (p < 0.05). By applying receiver operating characteristic (ROC) curve analysis, we found blood EOS number had a sensitivity of 84.9 % and specificity of 84.4 % [area under the curve (AUC): 0.873] at the cutoff level of 0.16 × 10(9)/L, and blood EOS ratio had a sensitivity of 89.0 % and specificity of 84.4 % (AUC: 0.863) at the cutoff level of 2.05 % in this cohort. Our findings indicated that smell loss score, ethmoid osteitis index and blood EOS number and ratio may be used for the differential diagnosis of ECRS as the surrogate markers.

[Clinical effect of clarithromycin therapy in patients with chronic rhinosinusitis]

OBJECTIVE

To evaluate the efficacy of clarithromycin (CAM) treatment in adult Chinese patients suffering from chronic rhinosinusitis with nasal polyps (CRSwNP) or without nasal polyps (CRSsNP).

METHODS

A prospective, open and self-controlled clinical trial on patients with CRS was conducted. Fifty patients met inclusion criteria. Of 50 patients, there were 33 patients with CRSsNP and 17 patients with CRSwNP. CAM was administered at 250 mg/d and the duration of administration was 12 weeks. Outcome measures included assessments of visual analogue scale (VAS), the sino-nasal outcome test-20(SNOT-20), the medical outcomes study short-form 36 items(SF-36), Lund-Kennedy endoscopy score, and Lund-Mackay computed tomography score. Before starting the treatment, 2 months after treatment and at the end of treatment, each patient had to complete all the measures except Lund-Mackay computed tomography score, which was only conducted before and after treatment. In order to evaluate the safety of CAM, liver function and renal function in all patients were detected before and after treatment. SPSS 16.0 software was used to analyze the data.

RESULTS

Forty-five patients completed 3 months follow-up and 5 patients withdrew due to different reasons. The results were as follows: (1) Thirty-three patients with CRSsNP's VAS scores of four time point were 5.81 ± 1.69, 3.76 ± 1.94, 2.98 ± 1.95, 2.06 ± 2.13, respectively, there were statistically significant improvements in turn (t values were 5.910, 8.090, 8.932, all P < 0.05). Endoscopy score of four time point were 6.28 ± 1.28, 5.00 ± 1.67, 4.12 ± 1.76, 3.12 ± 2.19, respectively, there were statistically significant improvements in turn compared with before treatment (t values were 6.662, 9.161, 9.936, all P < 0.05). The CT scores before and after treatment were 10.33 ± 4.65 and 4.67 ± 4.59, respectively (t = 7.226, P = 0.000) . (2) Seventeen patients with CRSwNP's VAS scores of four time point were 6.07 ± 2.02, 4.87 ± 2.61, 4.06 ± 2.85, 4.08 ± 2.80, respectively, there were statistically significant improvements after 2 or 3 months (t values were 3.285, 3.468, both P < 0.05) except after one month (t = 1.846, P > 0.05). Endoscopy score of four time point were 10.65 ± 1.77, 9.35 ± 1.93, 8.65 ± 2.76, 8.47 ± 2.76, respectively, there were statistically significant improvements in turn(t values were 4.068, 4.863, 5.156, all P < 0.05). The CT scores before and after treatment were 13.82 ± 4.94 and 11.41 ± 5.12, respectively (t = 3.975, P = 0.001). (3) During the period of CAM treatment, 1 patient reported a tolerable headache and weakness and 1 patient had abdominal pain after two months treatment, all the symptoms disappeared while they were asked to stop the drug. Liver function and renal function were detected in 40 patients, the differences before and after treatment were not significant statistically.

CONCLUSIONS

Long-term, low-dose CAM treatment is effective in the treatment of CRSsNP and CRSwNP in Chinese patients. Meanwhile, the efficacy of CAM is more significant in polyp-free group compared with polyp group. Low does CAM therapy is safe, and the liver function and renal function does not worsen after 3 months treatment.

Corticosteroid Regulates Epithelial Occludin Expression in Nasal Polyps through a MKP-1-Dependent Pathway

<b><i>Objective:</i></b> To evaluate the regulatory effect of corticosteroid on occludin expression in polyp tissues of chronic rhinosinusitis with nasal polyps (CRSwNP) patients and in vitro. <b><i>Methods:</i></b> Twenty CRSwNP patients were enrolled and subjected to prednisone (30 mg/day for 14 days). The expression of occludin in polyp tissues was examined before and after treatment using immunohistochemical staining and quantitative reverse transcription polymerase chain reaction. Moreover, the expression of occludin in polyp-derived epithelial cells (PECs) and human bronchial epithelial cells (BECs) was examined using Western blot analysis in the presence of corticosteroid and/or MKP-1 siRNA, respectively. <b><i>Results:</i></b> mRNA and protein expression of occludin in polyp tissues was significantly upregulated after prednisone administration (p < 0.05). Corticosteroids significantly increased MKP-1 and occludin expression in cultured PECs (p < 0.05), and MKP-1 siRNA significantly decreased occludin expression in cultured BECs (p < 0.05). <b><i>Conclusion:</i></b> Our findings suggest that corticosteroid can promote epithelial occludin expression in nasal polyps through a MKP-1-dependent pathway. i 2014 S. Karger AG, Basel

[Clinical observation of topical steroid for the treatment of chronic rhinosinusitis in Chinese adults]

OBJECTIVE

This study was focused on the clinical effects of topical steroid for chronic rhinosinusitis (CRS) in Chinese adults.

METHODS

The CRS patients were randomly selected in the department of otorhinolaryngology, first affiliated hospital of Sun Yat-sen university between november 2010 and December 2011. Thirty-four CRS patients with polyps (CRSwNP) or CRS without polyps (CRSsNP), no prior surgeries were included. These patients were prescribed to use budesonide nasal spay for three months. Evaluation included visual analog score (VAS), sino-nasal outcome test-20(SNOT-20), CT scan (Lund-Mackay score). SPSS 16.0 software was used to analyze the data.

RESULTS

Four patients were lost to follow up, while the other 30 patients finished the 3-months' follow up. Except for smelling disturbance which was not statistically changed (t = 0.902, P > 0.05), VAS for nasal blockage (baseline: 4.84 ± 3.15, after treatment: 2.26 ± 2.27), rhinorrhea (baseline: 6.03 ± 2.93, after treatment: 1.96 ± 2.23), headache (baseline: 1.68 ± 2.66, after treatment: 0.42 ± 0.95), facial pressure (baseline: 2.04 ± 2.97, after treatment: 0.58 ± 1.42) and general symptom (baseline: 6.00 ± 2.75, after treatment: 2.71 ± 1.90) were statistically decreased (t value was 4.386, 6.740, 2.445, 2.980, 6.989, respectively, all P < 0.05). VAS of nasal blockage, rhinorrhea and general symptom were statistically decreased after one-month's treatment (all P < 0.05), but no statistical improvements were observed between first, second and the third month (all P > 0.05). SNOT-20 was significantly decreased after treatment (t = 3.687, P < 0.01). 22.2% patients were cured on CT scan.

CONCLUSIONS

Topical steroid improves objective symptoms and quality of life in CRS patients. Some of the patients can be cured in CT scores. The symptoms improvements begin from the first month, but do not change during the latter two months.

[Salvage management and subsequent treatment after internal carotid artery injury during transnasal endoscopic surgery]

OBJECTIVE

To explore the cause, urgent management, further treatment, outcome and prevention of internal carotid artery (ICA) injury during transnasal endoscopic surgery.

METHODS

Five ICA injury happened during transnasal endoscopic surgery of sphenoidal sinus and (or) sellar region, involving 1 case of traumatic optic neuropathy, 1 case of sphenoidal cyst, 1 case of fungal sphenoid sinusitis, 1 case of sellar adenoid cystic carcinoma and 1 case of pituitary tumor. These five cases were from three different hospitals in 1990 - 2009, and the clinical data were collected and retrospectively reviewed.

RESULTS

Injury of ICA was related with improper anatomic localization and operative procedures. The locations of injury were in cavernous segment in 3 cases, lacerum segment in 1 case, and clinic segment in 1 case, respectively. The types of injury included 3 cases of bleeding of laceration, 1 case of carotid cavernous fistula and 1 case of pseudoaneurysm. Salvage sphenoid sinus packing with vaseline strip and subsequent intravascular stent graft implantation (2 cases) and endovascular embolization (2 cases) effectively controlled bleeding. Four cases were successfully treated without craniocerebral or ocular complications, only 1 case died of massive blood loss. Among 4 survival cases, 1 patient abandoned further therapy, the other 3 patients were cured of primary disease by reoperation or subsequent treatment.

CONCLUSION

Preoperatively, reading carefully the imaging data, intraoperatively, identifying anatomical positions accurately, performing proper operation, and stopping bleeding decidedly, postoperatively, seeking interdisciplinary cooperation to repair vascular damages, all these procedures can effectively reduce the surgical risk of ICA injury.

[Regularity of nasal mucous transitional course of different sinuses after functional endoscopic sinus surgery]

OBJECTIVES

To explore the time regularity of nasal mucous transitional course of different sinuses after functional endoscopic sinus surgery.

METHODS

Seventy-seven chronic rhinosinusitis patients following functional endoscopic sinus surgery were prospectively collected. The endoscopic appearances of different sinuses were respectively evaluated with Lund-Kennedy scoring system in 2 weeks, 1, 2, 3, 6, 9 months, and 12 months postoperatively. Then the endoscopic scores and epithelization proportions of different sinuses in different stages were analyzed and compared.

RESULTS

Of 77 patients, 154 maxillary sinuses, 154 ethmoidal sinuses, 138 frontal sinuses, and 129 sphenoidal sinuses were scored endoscopically and analyzed statistically. In the 2 weeks after operation, the mucosa scores of sphenoidal sinus (3.5 ± 1.5), ethmoidal sinus (3.6 ± 1.4), maxillary sinus (3.7 ± 1.5), and frontal sinus (3.8 ± 1.5) showed no significant differences by no parameter tests (χ(2) = 1.674, P = 0.643). In the 2, 3, 6, and 9 months postoperatively, the assessment of four kinds of sinuses showed separate transitional tendency and the descending deflection points of scores and ascending peaks of epithelization proportions gradually emerged. In the 12 months postoperatively, by the above statistical methods, the mucosal scores (Z = -3.417, P = 0.001) and epithelization proportions (χ(2) = 4.313, P = 0.038) of sphenoidal sinus were superior to that of ethmoidal sinus, the mucosal scores (Z = -2.218, P = 0.027) and epithelization proportions (χ(2) = 4.292, P = 0.038) of ethmoidal sinus were superior to that of maxillary sinus, and the mucosal scores (Z = -2.244,P = 0.025) and epithelization proportions (χ(2) = 4.100, P = 0.043) of maxillary sinus were superior to that of frontal sinus.

CONCLUSIONS

The transitional course of different sinus mucosa after functional endoscopic sinus surgery shows significant time difference. The time sequencing to complete epithelization of sinuses is successively sphenoidal sinus, ethmoidal sinus, maxillary sinus, and frontal sinus.

[Resection of petrous apex cholesteatoma via endoscopic trans-sphenoidal approach]

OBJECTIVE

To introduce our experience of resection of petrous apex cholesteatoma through endoscopic, transnasal, trans-sphenoidal approach in 3 cases, and present a surgical technique of intracystic resection of lesion which yielded a relatively stable long-term outcome.

METHODS

Resection of parasellar and petrous apex cholesteatoma via endoscopic transsphenoidal approach was performed in three patients between 2001 and 2006. Surgical technique was as follows: the ethmoid and sphenoid sinuses were opened under endoscope, the petrous apex was accessed by drilling skull base bone at the lateral wall of sphenoid sinus and anterior to the internal carotid artery, the cyst wall of cholesteatoma was incised and expanded, then intracystic removal of cholesteatoma was achieved by the suction, curette and rinsing.

RESULTS

The petrous apex cholesteatoma in all 3 patients were removed clearly by endoscopic, transnasal, trans-sphenoidal surgery in one time. Before surgery, two patients with headache and orbital apex syndrome had a remarkable improvement just on the day after operation and completely recovered in 1-4 weeks. No postoperative complications happened in all three patients. All patients had no recurrence in symptoms and no imaging evidences of recurrence at a follow-up of 3 - 7 years.

CONCLUSION

The petrous apex cholesteatoma around the parasellar region could be treated by intracystic removal via endoscopic, transnasal, transsphenoidal approach, without the need to strip and remove the cyst wall, and the long-term efficacy was reliable.

[Macrolide therapy on nasal mucosal persistent refractory inflammation after endoscopic sinus surgery]

OBJECTIVE

To examine the clinical effect of low-dose (250 mg/d), long-term (12 - 28 weeks) macrolide Klacid on the persistent refractory inflammation of paranasal sinus mucosa following endoscopic sinus surgery (ESS).

METHODS

Thirteen patients from a consecutive series of 141 patients undergoing ESS for chronic rhinosinusitis (CRS) during 2004 - 2006 for the first time were recruited for persistent refractory inflammation over 2 years postoperatively. All patients were given Klacid 250 mg/d orally for 12 - 28 weeks and simultaneously maintained the usual treatment including intranasal corticosteroid, mucolytics, and nasal douche. At the end of treatment and the sequential 3 and 6 months, 13 patients were evaluated by symptoms of visual analogue scale and nasal endoscopy by Lund-Kennedy scoring system, respectively.

RESULTS

Among the 13 patients, 1 patient stopped therapy for no obvious benefit 5 months after treatment, 12 patients finished the planned treatment till achieving the stopping therapy standard. Ultimately both symptom (8.00 [7.50, 8.50] and 1.00 [0.25, 1.00], Z = -3.201, P < 0.01) and endoscopic evaluation (7.00 [6.50, 8.00] and 1.00 [0.00, 1.00], Z = -3.194, P < 0.01) showed total remarkable improvement after therapy in 13 patients. The comprehensive assessment showed very good outcomes in 6 cases, good in 6 cases, and no good outcomes in 1 case, respectively. During the sequential 3 months and 6 months, no recurrent sinusitis and side effect happened in any patients.

CONCLUSIONS

It is effective to treat chronic refractory sinusitis with a low-dose (250 mg/d), long-term (12 - 28 weeks) Klacid on nasal mucosal persistent refractory inflammation after ESS. Klacid is well tolerated and safe to CRS patients during the use of 12 - 28 weeks.

Evaluation of long-term clarithromycin treatment in adult Chinese Patients with chronic rhinosinusitis without nasal polyps

OBJECTIVE

To evaluate the efficacy of long-term clarithromycin (CAM) treatment in adult Chinese patients suffering from chronic rhinosinusitis without nasal polyps (CRSnNP).

METHODS

Thirty-three CRSnNP patients were enrolled and subjected to CAM treatment for 12 weeks (250 mg daily). The total nasal symptom scores (TNSS), nasal resistance and inflammatory mediators including interleukin (IL)-8 and myeloperoxidase (MPO) were evaluated at weeks 0 and 12. Quality of life (QoL) was assessed in all patients by using the Sinonasal Outcome Test 20 and Short Form 36 questionnaires.

RESULTS

CAM treatment significantly improved TNSS, nasal resistance and QoL, and it inhibited IL-8 and MPO production in CRSnNP patients (p < 0.05). CAM treatment was more effective for IL-8(high) CRSnNP patients than for IL-8(low) CRSnNP patients (p < 0.05).

CONCLUSION

Long-term, low-dose CAM treatment is effective and safe for the treatment of CRSnNP in Chinese patients.

[Transnasal endoscopic frontal sinus surgery using expanded agger nasi approach]

OBJECTIVE

To explore the feasibility of endoscopic modified agger nasi approach for the surgical treatment of frontal sinus diseases.

METHODS

The data of patients undergoing modified agger nasi approach for frontal diseases were prospectively collected since January 2009, including demographic data, findings at surgery, presence of postoperative symptoms, endoscopic appearance of the frontal recess and sinus, and complications.

RESULTS

Nineteen patients were enrolled from January 2009 to August 2010. Seventeen patients had chronic rhinosinusitis, in which 13 patients (76.5%) completely healed, 3 patients (17.6%) improved and 1 patient (5.9%) failed. Two patients had frontal sinus and anterior ethmoid sinus inverted papilloma, with no recurrence. The patients were followed up from 6 to 24 months, medium 16 months. No severe complication occurred. No frontal recess adhesion was found. Four sides of frontal recess showed stenosis caused by tissue hypertrophy.

CONCLUSION

The modified agger nasi approach provides excellent access to frontal recess and frontal sinus, with good effect for preventing re-stenosis after surgery.

[Efficacy of endoscopic sinus surgery-based on multidisciplinary treatment for chronic rhinosinusitis with asthma]

OBJECTIVE

To evaluate the efficacy of endoscopic sinus surgery (ESS)-based on multidisciplinary treatment for patients with chronic rhinosinusitis (CRS) and asthma.

METHODS

The study included 25 CRS patients with asthma who received ESS from September 2006 to March 2009, besides surgery, who also used corticosteroid nasal spray, oral macrolide antibiotics and nasal irrigation perioperatively. Evaluation was performed before ESS, 1 year and 3 years post-ESS. Evaluation index included visual analogue scale (VAS) and endoscopy Lund-Kennedy assessment for CRS, and asthma control test (ACT) and pulmonary function tests for asthma.

RESULTS

Twenty-three (92%) patients were followed up for 12 months. Twelve (48%) of them were followed up for 36 months. CRS efficacy: VAS of general symptom significantly improved after ESS compared to pre-ESS (8.12 ± 0.60, x(-) ± s), after 1 year (3.20 ± 2.19) and 3 year (3.79 ± 2.32) follow up (both P = 0.000). There was no statistic difference between 1 year and 3 year follow up (P = 0.851). Endoscopy Lund-Kennedy score significantly improved in post-ESS after 1 year (4.35 ± 3.21) and 3 year (5.50 ± 2.64) follow up compared to pre-ESS (9.80 ± 2.10, both P = 0.000), and there was no difference between 1 year and 3 year follow up (P = 0.606). Asthma efficacy: ACT pre-ESS, 1 year and 3 year were 21.96 ± 2.16, 23.61 ± 1.94 and 22.33 ± 3.47, without statistic difference (F = 2.871, P = 0.065). Pulmonary function showed no significant change after surgery (Pre-ESS 74.68 ± 11.09, 1 year 73.27 ± 12.27, 3 year 73.50 ± 7.87, F = 0.076, P > 0.05).

CONCLUSIONS

ESS improves CRS with asthma significantly and persistently. Asthma control level, anti-asthma drug dose and pulmonary function remain stable after ESS.

[Clinical study on mometasone furoate nasal spray in the treatment of non-allergic rhinitis]

OBJECTIVE

To evaluate the outcome of mometasone furoate nasal spray (MFNS) used for 3 months on non-allergic rhinitis (NAR).

METHODS

In this multicenter study, NAR patients were enrolled from eight hospitals and received MFNS 200 microgram once daily for 3 months. The patients were followed-up for three times (at baseline, month 1 and month 3) to record the symptom scores and nasal endoscopic appearances. At the same time, the adverse events frequency was recorded and analyzed.

RESULTS

A total of 188 NAR cases were enrolled in the study. The total nasal symptom score assessment descended significantly at month 1 (1.70 ± 0.75) and month 3 (0.95 ± 0.79) visits versus at baseline (2.67 ± 0.68, Z value were from -11.603 to -10.491, all P < 0.01). The individual symptoms, including nasal stuffiness, nasal discharge, nasal stuffiness-related dizziness or headache, hyposmia, sleep quality, daily life activity, work or study efficiency, mental status, and whole body fatigue, also showed less scores at month 1 and month 3 visits versus at baseline (Z value were from -11.313 to -6.802, all P < 0.01). At the same time, nasal mucosal appearances assessed by endoscopy had lower scores at month 1 (1.40 ± 0.62) and month 3 (0.75 ± 0.71) visits versus at baseline (2.27 ± 0.73, Z value were from -11.484 to -10.002, all P < 0.01). Additionally, adverse events were only observed in 5.3% cases with light rhinorrhagia and nasal dryness. No other side effect was found.

CONCLUSIONS

A 3-months administration of intranasal mometasone can effectively and safely improve NAR patients' clinical symptom and nasal mucosal appearances.

[Investigation of relevant factors on refractory chronic rhinosinusitis]

OBJECTIVE

To explore the relationship between the bacterial biofilm, allergy, inflammatory cytokines and refractory rhinosinusitis.

METHOD

According to the assessment of symptom by visual analogue scale and nasal endoscopy by Lund-Kennedy system, 19 patients with persistent chronic rhinosinusitis and 6 patients with curative chronic rhinosinusitis were recruited from 340 chronic rhinosinusitis patients underwent functional endoscopic sinus surgery for the first time and received standard medication postoperatively. These cases were divided into the study group and the control group respectively. Electron microscope scanning and enzyme linked immunosorbent assay were used to observe the bacterial biofilm formation on ethmoid sinus mucosal surface and detect the concentration of specific IgE and interleukin (IL) 4, IL-5, IL-6, and IL-8 in ethmoid sinus mucosal tissue. Then the differences between the two groups of cases were analyzed statistically.

RESULT

(1) Bacterial biofilms: nineteen cases from the study group were all found biofilm formation in ethmoid sinus, besides the damage of epithelial cells and cilia. Six cases from the control group were found no biofilm, with the integrity of epithelial cells and cilia. Statistical analysis showed significant differences in biofilm detection rate between the two groups (P < 0.01). (2) Specific IgE: specific IgE was detected in nine cases from the study group and was not found in any case from the control group, with a significant difference between them (P < 0.05). (3) IL: IL concentration was all detected under normal value both in the study group and the control group, except for only 2 cases from the study group with higher IL-8 concentration. Positive reaction to IL was detected as follows: IL-4 (7 cases), IL-5 (14 cases), IL-6 (15 cases), and IL-8 (12 cases) in the study group; IL-4 (1 case), IL-5 (5 cases), IL-6 (5 cases), and IL-8 (5 cases) in control group. No difference in IL detection rate was found between the two groups (P > 0.05).

CONCLUSION

Bacterial biofilm and allergic inflammation are important factors resulting into refractory chronic rhinosinusitis.

Opposing roles of IL-17A and IL-25 in the regulation of TSLP production in human nasal epithelial cells

BACKGROUND

The importance of IL-17A, IL-17F, and IL-25 in allergic rhinitis (AR), as well as their possible role in regulation on thymic stromal lymphopoietin (TSLP) production in nasal epithelial cells, is not well understood.

OBJECTIVE

To determine the possible regulation of IL-17A, IL-17F, and IL-25 on TSLP production in the initiation of allergic responses.

METHODS

The levels of IL-17A, IL-17F, IL-25, and TSLP in nasal lavages of patients with AR were measured using an enzyme-linked immunosorbent assay (ELISA) and compared with that in normal controls. Then, primary human nasal epithelial cells (HNECs) were stimulated with dsRNA (0-75 microg/ml), as well as IL-17A (100 ng/ml), IL-17F (100 ng/ml), and IL-25(100 ng/ml). The mRNA expression of IL-17A, IL-17F, IL-25, TSLP, as well as the chemokines CCL20, IL-8, and eotaxin was analyzed using quantitative real-time PCR, and their protein levels in the supernatants of cultured HNECs were determined by ELISA.

RESULTS

Both TSLP and IL-17 cytokines are significantly elevated in patients with AR. dsRNA was found to increase the production of IL-17F, IL-25, TSLP, CCL20, and IL-8 in HNECs. Furthermore, IL-25 significantly enhanced dsRNA-induced TSLP production in primary HNECs and was dominant to the inhibitory effect of IL-17A on TSLP regulation.

CONCLUSIONS

Our study provides the first evidence that both IL-17F and IL-25 can be induced by dsRNA in HNECs. Despite of the opposing effects of IL-17A and IL-25 on TSLP regulation in HNECs, IL-25 was dominant to IL-17A, providing a plausible explanation for the simultaneous upregulation of IL-17 cytokines and TSLP in patients with AR.

Molecular detection of Muscovy duck parvovirus by loop-mediated isothermal amplification assay

Muscovy duck parvovirus (MDPV) usually causes high morbidity and mortality in 1- to 3-wk-old Muscovy ducklings due to serious infections, which is an imminent threat to the commercial duck industry in China. The objectives of this study were to develop and evaluate a simple, rapid, and inexpensive loop-mediated isothermal amplification (LAMP) method for specific detection of MDPV and to compare it with the PCR method in rapidity, sensitivity, and accuracy. The novel LAMP assay used a set of 4 specific primers to recognize 6 distinct genomic sequences of capsid protein (VP3) from MDPV, which could be completed within 50 min at 63 degrees C in a simple water bath. The diagnostic results demonstrated that the LAMP assay detected all 7 preserved MDPV isolates, had no cross-reactivity with other duck pathogens (i.e., goose parvovirus, duck plague virus, H9N2 avian influenza virus, duck hepatitis type virus I, and Muscovy duck reovirus). The LAMP assay was at least 10-fold more sensitive than the routine PCR assay and obtained more sensitivity in 61 clinical samples. Therefore, the newly developed LAMP assay provides a specific and sensitive means for detecting MDPV and can be simply applied both in field conditions and in laboratory operations in a cost-effective manner with primary care facilities.

[Clinical effects of nasal glucocorticoid on amelioration of nasal obstruction in patients with persistent non-allergic rhinitis]

OBJECTIVE

To observe the efficacy of nasal glucocorticoid continuously used for 12 weeks on nasal obstruction in patients with persistent non-allergic rhinitis (PNAR).

METHODS

The changes of nasal obstruction, nasal resistance, nasal mucous membrane and quality of life in 47 patients with PNAR were observed. The efficacy of nasal glucocorticoid (Mometasone Furoate Nasal Spray, MFNS 200 microg/day) on patients with PNAR was evaluated.

RESULTS

The results of nasal glucocorticoid (MFNS) continuously used for 12 weeks demonstrated: (1) After treatment, the nasal obstruction, nasal discharge, nasal obstruction related dizziness, headache, hyposmia, daily life activity, whole body fatigue, mental status were significantly improved (P < 0.05). (2) Nasal resistance showed significant amelioration (pre-treatment = 0.28 +/- 0.10, post- treatment = 0.16 +/- 0.05; F = 91.471, P < 0.05). (3) SF-36 questionnaire revealed that role physical, bodily pain, general health, role emotional had significant amelioration (P < 0.01). (4) SNOT-20 questionnaire revealed that the defatigation, impaired concentration, pinch the nose, nasal discharging into the throat, sleep quality had significant amelioration (P < 0.01). (5) Continued treatment for 12 weeks was better than 4 weeks, continued treatment had good effect.

CONCLUSION

The study shows that nasal glucocorticoid improved the nasal obstruction, nasal resistance, nasal mucous membrane and quality of life in patients with PNAR.

Interleukin-6 is essential for Staphylococcal exotoxin B-induced T regulatory cell insufficiency in nasal polyps

BACKGROUND

The pathogenesis of nasal polyps is still unclear. There is increasing evidence indicating that Staphylococcal aureus (S. aureus) is associated with the formation of nasal polyps, but the mechanism has not been well documented to date.

METHODS

We stimulated cultured nasal polyps and turbinate tissues with Staphylococcal exotoxin B (SEB), detected the expression of pro-inflammatory cytokines (IL-2, IL-6, and IL-8) and T cell cytokines (IFN-gamma, IL-4, IL-5, IL-10, and IL-17) in the supernatants, and evaluated mRNA expression (T-bet, GATA-3, Foxp3, and RORgammat) and frequencies of CD4+CD25+ T regulatory cells (Tregs) in nasal tissues. We also evaluated the effects of blocking IL-6 with monoclonal antibodies to T cell profiles in cultured nasal tissues stimulated by SEB.

RESULTS

Levels of IL-6, IFN-gamma and IL-4 increased significantly in SEB-stimulated nasal polyps. Meanwhile, mRNA expressions of T-bet and GATA-3 were significantly up-regulated, while Foxp3 was inhibited and the frequencies of CD4+CD25+ Tregs were decreased after SEB stimulation. After blocking IL-6, the levels of IL-10 and Foxp3 mRNA, as well as the frequencies of CD4+CD25+ Tregs, were significantly increased, while IFN-gamma and IL-4 production and the mRNA expression of T-bet and GATA-3 were significantly inhibited.

CONCLUSIONS

SEB is able to modulate pro-inflammatory factors, T-helper type 1/Th2 profiles and suppress Treg activity in cultured nasal polyps, which were rescued by blocking IL-6 activity. Therefore, IL-6 is essential for SEB-induced Treg insufficiency in nasal polyps.

[Development of the Sino-Nasal Outcome Test-20 Chinese version (SNOT-20 CV)]

OBJECTIVE

To develop the Sino-Nasal Outcome Test-20 Chinese Version (SNOT-20 CV).

METHODS

By introducing, translating, pretesting, adjusting, and performance testing of SNOT-20 inventory, a Chinese draft scale came into being. On the basis of the clinical applications and feedbacks from ten domestic hospitals, the scale was further modified and was more strictly tested in sixty patients with chronic rhinosinusitis, and then its psychometric properties were compared with that of the original edition.

RESULTS

The SNOT-20 CV showed the following psychometric properties: The scale was easily accepted and answered in patients, showing a satisfactory feasibility. The split-half reliability, Cronbach' alpha and intraclass correlation coefficient were 0.95, 0.88, and 0.98, respectively. The content validity was approved by experts of working group. The criteria validity calculated between SNOT-20 and SF-36 was -0.67. Factor analysis of construct validity showed that the comparative fit index was 0.93 and the 20 items were classified into 4 domains which were accorded with the designed constructs. The category rating system was of reasonable additivity and comparability. Every domain was of sensitivity to effectively discriminate between patient population and healthy population (P < 0.01). The standardized response mean of twenty items and five important items at three months postoperatively was respectively 0.48 and 0.57, suggesting moderate responsibility to clinical change. SNOT-20 CV passed the tests of feasibility, reliability, validity, scalability, sensitivity, and responsibility, showing good properties comparable to that of the original edition.

CONCLUSIONS

SNOT-20 CV passes the psychometric and clinimetric tests and can be used for measuring rhinosinusitis-specific quality of life in China.

Numerical flow simulation in the post-endoscopic sinus surgery nasal cavity

In this study we utilized computational fluid dynamic (CFD) techniques to construct a numerical simulation of nasal cavity airflow pre and post virtual functional endoscopic surgery (FESS). A healthy subject was selected, and CFD techniques were then applied to construct an anatomically and proportionally accurate three-dimensional nasal model based on nasal CT scans. A virtual FESS intervention was performed numerically on the normal nasal model using Fluent software. Navier-Stokes and continuity equations were used to calculate and compare airflow, velocity, distribution and pressure in both the pre and post FESS models. In the post-FESS model, there was an increase in airflow distribution in the maxillary, ethmoid and sphenoid sinuses, and a 13% increase through the area connecting the middle meatus and the surgically opened ethmoid. There was a gradual decrease in nasal resistance in the posterior ethmoid sinus region following FESS. These findings highlight the potential of this technique as a powerful preoperative assessment tool to aid clinical decision-making.

[Subjective and objective clinical outcome assessment on chronic rhinosinusitis following endoscopic sinus surgery]

OBJECTIVE

To assess the subjective and objective outcomes of chronic rhinosinusitis (CRS) following endoscopic sinus surgery (ESS) and establish an assessment system of outcome with ease of application clinically.

METHODS

A prospective cohort study was conducted to survey and assess the outcomes of 120 consecutive CRS patients undergoing endoscopic sinus surgery at 12 months after operation. The subjective and objective measures comprised symptom by visual analog scale (VAS), health-related quality of life by medical outcome study short-form 36-items (SF-36) and sino-nasal outcome test-20 (SNOT-20) scales, endoscopic appearance, mucociliary function, and histological findings. The differences of subjective and objective assessments before and after operation were compared by t-test and Chi-Square test and the correlations between the parameters above were analyzed by Spearman correlation analysis.

RESULTS

At 12 months after operation, the patients' total scores by VAS, SF-36 and SNOT-20 scales improved significantly beyond the preoperative survey (P < 0.01); there were 85.96%, 77.19% and 83.33% patients with the scores respectively superior to that of preoperation, of which 72.28% subjects benefited simultaneously from these parameters; and a significant correlation was observed among them before and after operation (P < 0.01) where SNOT-20 showed a more compatibility than the other two. At 12 months after operation, the patients' total scores of endoscopic appearance, mucociliary function, and histological findings significantly improved beyond the preoperative evaluation (P < 0.05); there were 86.84% , 86.81% and 75.57% patients with the scores respectively superior to that of preoperation, of which 71.85% subjects benefited simultaneously from these parameters; and a significant correlation was observed among them before and after operation (P < 0.05) where endoscopic appearance showed a more compatibility than the other two. At 12 months after operation, 74.56% patients showed an accordant improving or worsening outcome evaluated by SNOT-20 and endoscopic appearance, while 25.44% ones represented inverse endings, of which patients with comorbidity of nasal polyps more easily demonstrated this tendency significantly (P < 0.05). No significant correlation existed between the scores of SNOT-20 and endoscopic appearances both in preoperation and in postoperation (P > 0.05), but the total scores of the anterior 10-item, excluding the posterior 10-item, of SNOT-20 inventory was found significantly correlated with the quantitative appearances on nasal endoscopy throughout (0.18 < or = 0.42, P < 0.05).

CONCLUSIONS

Administration of ESS can effectively improve the outcomes of CRS patients including symptom, health-related quality of life, endoscopic appearance, mucociliary function, and histological findings. A subjectively and objectively measured assessment system with tenseness, trustiness, reasonableness, and effectiveness and with ease of application clinically is established on the basis of SNOT-20 and endoscopic appearance evaluation for outcome research.

[Postoperative symptoms and life quality assessment of chronic rhinosinusitis patients received endoscopic sinus surgery]

OBJECTIVE

To implore the positive effects of endoscopic sinus surgery on the symptoms and quality of life (QOL) of patients with chronic rhinosinusitis (CRS) and their changing regularity of symptoms and QOL.

METHODS

A prospective, randomized and controlled trial was conducted to survey symptoms and QOL status of 120 CRS patients undergoing endoscopic sinus surgery, in contrast to that of 200 healthy individuals passing health examination, at the baseline and at 3- and 6-months postoperatively by visual analog score (VAS) symptom instrument and QOL instruments including medical outcome study short-form 36-items health survey (SF-36) and sino-nasal outcome test-20 (SNOT-20).

RESULTS

In the 3 months follow-up settings, total of individual symptom severity scores and global symptom severity scores of VAS, such domains as role physical and general health of SF-36 and total of the 20 items scores and the most important 5-item scores of SNOT-20 all began to get better markedly (P < 0.05); in the 3-6 months follow-up settings, the indices above stayed fixed (P > 0.05); and in the 6-months follow-up settings, indices of symptoms and QOL status entirely improved from the baseline, with SF-36 showing no scoring difference between CRS patients and healthy individuals, whereas VAS showed that abnormal nasal drainage and decreased sense of smell were still left and SNOT-20 showed that abnormal nasal drainage and lack of good sleep left, inferior to that of healthy objects significantly (P < 0.05).

CONCLUSIONS

On the whole CRS patients undergoing endoscopic sinus surgery recover symptomatically and come back to normal level of QOL status at the 6 months postoperatively, but such significant problems as abnormal nasal drainage, decreased sense of smell and lack of good sleep still remain and need to be treated.

[Quality of life survey on patients with chronic rhinosinusitis and nasal polyps]

OBJECTIVE

To explore the health-related quality of life (QOL) status of patients with chronic rhinosinusitis and nasal polyps.

METHODS

One hundred and twenty patients with chronic rhinosinusitis and nasal polyps and two hundred individuals passing health examination were enrolled by random and their QOL scores were assessed by using QOL instruments including existing SF-36 questionnaire (Chinese version ) and SNOT-20 questionnaire translated into Chinese, of which clinimetric and psychometric properties were tested.

RESULTS

The feasibility, reliability, validity, and responsibility of Chinese version of SNOT-20 questionnaire all passed the test. By the assessment of SF-36 questionnaire, it revealed that scores of six domains such as physical functioning, role physical, bodily pain, mental health, vitality, and general health from patients with chronic rhinosinusitis and nasal polyps were lower than that of control group except social functioning and role emotional (P < 0.05). It showed by Chinese version of SNOT-20 questionnaire that patients exceeded healthy individuals in the scores of twenty items of three domains including physical problems, functional limitations, and emotional consequences, of which the most five important items affecting health status were respectively need to blow nose, thick nasal discharge, lack of a good night's sleep, dizziness, and post-nasal discharge (P < 0.05).

CONCLUSIONS

QOL instruments such as Chinese version of SF-36 and SNOT-20 questionnaires can effectively differentiate the QOL status between patients with chronic rhinosinusitis and nasal polyps and healthy individuals. The negative impact of chronic rhinosinusitis and nasal polyps on patients' QOL includes physical functioning, role physical, bodily pain, mental health, vitality, general health, and emotional consequences. The problems of nasal discharge, sleep, and dizziness should be sufficiently emphasized in clinical treatment.

[Endoscopic evaluation of mucous membrane inflammation in chronic rhinosinusitis and analysis of correlated factors]

OBJECTIVE

The purpose of this article is to establish an endoscopic score system for quantitative evaluation of the inflammation of mucous membrane in patients with chronic rhinosinusitis (CRS) , and to investigate the correlation of this system with a variety of clinical factors.

METHODS

A set of score system was constructed based on anatomic configuration, status of mucous membrane and nasal secretion to evaluate quantificationally the severity of inflammation of CRS. The clinical correlation of this system was studied prospectively in 60 CRS patients, with a variety of clinical factors which included age, duration of disease, previous recurrence and the years from recent recurrence, atopy, serum total immunoglobulin E (TIgE), serum eosinophil cationic protein (ECP), the count of blood eosinophil, the count of tissue inflammatory cell, the extension of CRS indicated by CT, smoking, concomitant chronic inflammation in lower respiratory tract. All above factors were analyzed statistically with the endoscopic score by Pearson correlation and multi-factor linear regression analysis.

RESULTS

In pearson analysis, the correlative factors with the evaluated score included age (x1, r = - 0.310, P = 0.016), the extension of disease (x2, r = 0. 810, P < 0.0005), recurrence (x3, r = 0.408, P = 0.001), eosinophil of nasal tissue (x4, r = 0.279, P = 0. 031), duration of disease (x5, r = 0.536, P < 0.0005), concurrent nasal polyps (r = 0.549, P < 0.0005), plasm cell (r = 0. 317, P = 0.014) and years from the recent recurrence (r = 0.385, P = 0.002). In multi-factor linear regression, the five independent predictive factors were recurrence, age, extension of disease, tissue eosinophils, years of disease. The regressive equation is y = 10.148 - 0.152 (x1) + 2.250 (x2) + 3.348 (x3) + 1.233 (x4) + 0.270 (x5).

CONCLUSIONS

Appropriate score system by nasal endoscopy is feasible to evaluate quantificationally the degree of inflammation of CRS; being appropriately modified, it is even able to reveal the underlying histological behavior finely.

[Bacteriological study of chronic sinusitis]

OBJECTIVE

To explore the characteristics of bacteria isolated from patients with chronic sinusitis (CR) and antibiotic-resistance.

METHODS

The purulent discharges taken from the maxillary sinus and posterior ethmoid sinus of 76 patients during endoscopic sinus surgery were cultured for both bacteria and fungi, then the antimicrobial susceptibility test and beta-lactamase-producing bacteria (beta-LPB) were detected. In the control group, the discharges from the nasal cavity from 10 healthy adults were also cultured for bacteria.

RESULTS

Twenty species, including Staphylococcus epidermidis, Escherichia coli, Staphylococcus aureus, alpha-Hemolytic streptococcus and Streptococcus pneumoniae, were cultured from the testing group. The total positive rate of bacteria was 81.8%. The detectable rates of aerobe, anaerobe, gram-positive bacteria and gram-negative bacteria were 83.4%, 16.6%, 56.3% and 43.7%, respectively. The fungi was only detected in 1.4% patients. The antimicrobial susceptibility test demonstrated that Imipenem, Cefotaxime and Amoxicillin-clavulanate were good in vitro activity to aerobic pathogens and Metronidazole, Imipenem and Chloramphenicol was good to anaerobic pathogens. The beta-LPB was detected in 37.7% strains in which Staphylococcus epidermidis, Staphylococcus aureus, alpha-Hemolytic streptococcus and Branhamella catarrhalis were more frequent. Five species including Staphylococcus epidermidis and Escherichia coli etc were cultured from the control group. There was no significant difference of distribution of the same bacteria between the control group and the testing group (P > 0.05).

CONCLUSIONS

The pathogenic bacteria of CR mostly involve aerobes. The antibiotics-resistance of these pathogen is serious. The bacterial infection plays no leading role in CR, so the need of antibiotics should not be excessively emphasized. Before treatment by antibiotics, the antimicrobial susceptibility test should be performed. The broad-spectrum antibiotics containing beta-lactamase inhibitor such as Cefotaxime and Amoxicillin-clavulanate is recommended in condition that the test can not be finished.

Genetic diversity evaluation of some Chinese elite cotton varieties with RAPD markers

RAPDs analysis was used to assess the genetic diversity of some elite cotton varieties. 17 cotton varieties or breeding lines were screened with 200 arbitrary primers to generate 113 polymorphic bands. Cluster analysis and UPGMA showed that 17 varieties could be put into 3 clusters corresponding to genome difference. The genetic similarity among them ranged from 0.2000 to 0.8451. Three elite varieties Ejing-1, Sumian-3 and Zhongmiansuo-12 are highly similar in genetic base. 7581, an offspring from Gossypium hirsutum x G. hirsutum race Latifolium, is distinct from other upland cotton varieties. A trend in germplasm usage in the same research center was also shown in the study. To sustain progress in genetic improvement, we suggest that some good gene from other species should be considered in the upland cotton breeding procedure.