The role of serum macrophage migration inhibitory factor in preoperative prediction of chronic rhinosinusitis with nasal polyps endotypes

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a highly heterogeneous disease and can be categorized into eosinophilic CRSwNP (eCRSwNP) and non-eosinophilic CRSwNP (neCRSwNP). Exploring effective biomarkers to distinguish endotypes is important for personalized therapies. The present study aims to evaluate the predictive value of serum MIF in CRSwNP endotypes.

METHODS

One hundred and twenty CRSwNP patients, including 51 eCRSwNP and 69 neCRSwNP, 40 chronic rhinosinusitis without nasal polyps (CRSsNP) patients and 40 healthy controls (HC) were enrolled. Serum MIF levels were determined by enzyme-linked immunosorbent assay (ELISA). The patients' clinical variables were analyzed for correlations with serum MIF. Receiver operating characteristic (ROC) curve and multivariate analysis were utilized to assess the predictive value of serum MIF in CRSwNP endotypes.

RESULTS

The serum MIF levels were significantly higher in CRSwNP group than CRSsNP group and HC group (P < 0.001), and the serum MIF levels were increased in eCRSwNP compared to neCRSwNP group (P = 0.006). Elevated serum MIF levels were significantly correlated with blood eosinophil (B-EOS) count (r = 0.411, P < 0.001), B-EOS percentage (r = 0.377, P < 0.001), visual analog scale score (r = 0.204, P = 0.025), tissue eosinophil (T-EOS) count (r = 0.705, P < 0.001) and T-EOS percentage (r = 0.671, P < 0.001) in CRSwNP patients. ROC curve demonstrated that serum MIF exhibited good preoperative prediction in CRSwNP endotypes (area under the curve = 0.925, P < 0.001). Multivariate regression analysis showed that serum MIF was an independent factor associated with CRSwNP endotypes.

CONCLUSIONS

This was the first study identifying serum MIF as a possible specific biomarker for preoperatively distinguishing CRSwNP endotypes. Furthermore, the serum MIF levels were found to be closely associated with the degree of mucosal eosinophil infiltration.

A proinflammatory marker in chronic rhinosinusitis: serum calprotectin

INTRODUCTION

Studies have shown that calprotectin has a strong pro-inflammatory effect. Elevated calprotectin levels in the serum can be used as a strong clinical marker indicating the presence of inflammation.

OBJECTIVE

To investigate serum calprotectin levels in patients with chronic rhinosinusitis (CRS) and to determine the applicability of calprotectin as a potential molecular pro-inflammatory biomarker for CRS.

METHODS

The study consisted of three groups: chronic rhinosinusitis with polyps (CRSwNP group), chronic rhinosinusitis without polyps (CRSwoNP), and healthy control. CRS patients with polyps were further divided into two groups depending on the presence/absence of Samter's triad. The Nose Obstruction Symptom Evaluation (NOSE) scale score and serum calprotectin value were evaluated in all participants.

RESULTS

The mean serum calprotectin value was 79.5±11.8 ng/ml for the CRSwNP group, 71.3±16 ng/ml for the CRSwoNP group, and 61.9±11.6 ng/ml for the control group (p<0.001). The Samter's triad group had a significantly higher calprotectin value than the non-Samter's triad group (p=0.03). There was a significant correlation between the NOSE scores and calprotectin levels (rho=0.734, p<0.001).

CONCLUSION

Serum calprotectin values were correlated with the severity of symptoms in patients with CRS; thus, it seems to be a valuable pro-inflammatory biomarker for the diagnosis of the disease and determining its severity. Further studies with larger series are needed to evaluate the preoperative and postoperative serum calprotectin values ​​in patients undergoing surgery.

Chronic rhinosinusitis in eosinophilic granulomatosis with polyangiitis: clinical presentation and antineutrophil cytoplasmic antibodies

BACKGROUND

In this study we aim to describe presenting characteristics and identify prognostic factors for disease resolution in patients with chronic rhinosinusitis (CRS) in the setting of eosinophilic granulomatosis with polyangiitis (EGPA).

METHODS

Patients evaluated at a tertiary care center with diagnoses of EGPA and CRS were identified. Descriptive statistics were obtained. Univariate analysis was used to search for prognostic factors associated with higher Lund-Mackay score at presentation and disease resolution.

RESULTS

Forty-four patients were included with a mean age of 52.7 (standard deviation, 14) years. Twenty-one patients (47.7%) were female, all had a diagnosis of asthma, and 36 (83.7%) had eosinophils >10%. Common presenting symptoms for CRS included nasal discharge (87.9%) followed by nasal congestion (83.9%) and facial pain and pressure (83.8%). Medical management of CRS included systemic corticosteroids (93.2%) and systemic antibiotics (75%). Surgical intervention occurred in 29 patients (67%). Nine patients (20.5%) had resolution of sinus symptoms, including 4 with imaging confirmation. Fourteen patients (31.8%) had continued CRS, but with improved symptoms, whereas 9 patients (20.5%) had continued CRS with no improvement in symptoms. Eleven patients (25%) were lost to follow-up and 4 (9.1%) died. Univariate analysis did not show antineutrophil cytoplasmic antibody positivity, presence of peripheral eosinophilia, gender, age, or absence of systemic therapy to be predictive of higher Lund-Mackay score at presentation or predictive of disease resolution.

CONCLUSION

CRS in patients with EGPA is often refractory to medical and surgical management. Treatment of these patients should occur in a multidisciplinary setting.

Clinical and Immunological Features of 78 Adult Patients with Primary Selective IgG Subclass Deficiencies

The purpose of this study is to describe both clinical and immunological features in large cohort of adult patients with IgG subclass deficiency, and response to immunoglobulin therapy. This is a retrospective study of data obtained from electronic medical records and paper charts of 78 patients with IgG subclass deficiency seen and followed at our immunology clinics from 2010 to 2016. Both isolated selective IgG subclass deficiency as well as combined (two) subclass deficiencies were observed. IgG3 subclass deficiency, isolated and in combination with other IgG subclass deficiency, is the most frequent of IgG subclass deficiency. A majority of patients presented with upper and lower respiratory tract infections, especially chronic sinusitis. Both allergic and autoimmune manifestations are common; however, there is no subclass preference. The proportions and absolute numbers of CD3⁺ T cells, CD4⁺ T and CD8⁺ T cells, CD19⁺ B cells, and CD3^-CD16⁺CD56⁺ NK cells were normal in the majority of patients in all IgG subclass deficiencies. Total serum IgG levels did not correlate with IgG subclass levels across all IgG subclass deficiencies. Anti-pneumococcal polysaccharide antibody responses were impaired in 56% of patients. IgG3 subclass deficiency is the most common IgG subclass deficiency, and anti-polysaccharide antibody responses are distributed among IgG subclasses with modest preference in IgG2 subclass. The majority of patients treated with immunoglobulin responded by reduction in frequency of infections and requirement of antibiotics.

The Levels of Serum Biomarkers in Stable Asthma Patients with Comorbidities

The effects of comorbidities on systemic inflammation markers in stable asthmatics and the consequences of such effects have not been well evaluated. We aimed to evaluate the effect of comorbidities on clinical manifestations and systemic inflammation in asthmatic patients under control. The study group consisted of asthmatic patients who applied to our pulmonology outpatient clinic and volunteered to participate. 120 clinically stable asthma patients (71 females and 49 males) and 35 healthy controls (19 females and 16 males) with similar age, gender, and body mass index distributions were admitted to the study. The levels of osteopontin, interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 13 (IL-13), eosinophilic cationic protein, adiponectin, and high-sensitivity C-reactive protein of the individuals were evaluated using commercial ELISA kits by taking venous blood samples. Of 120 asthmatic subjects, 47 (39, 2%) had comorbidities and allergic rhinitis (15%) coexisted most frequently. Other comorbidities associated with asthma were gastroesophageal reflux, sinusitis, hypertension, diabetes, gastritis, and peptic ulcus respectively. There was no physician-diagnosed comorbidity in the control group. The levels of IL-6 and IL-8 were found higher in asthma group with comorbidities when compared to those with no comorbidities (p were 0.032 and 0.046, respectively). Comorbidities interfere with the diagnosis and treatment of asthma, besides affecting the disease control. Our findings suggest the possibility of the impact of comorbidities on systemic inflammation markers, especially IL-6 and IL-8. To evaluate the impact of comorbidities on asthma control and systemic markers, further studies are needed.

Vitamin D deficiency are associated with subjective disease severity in Chinese patients with chronic rhinosinusitis with nasal polyps

OBJECTIVE

To evaluate the serum vitamin D level in patients with chronic rhinosinusitis with nasal polyps and its correlation with the disease severity.

SETTING

Hospital of Zhejiang University.

STUDY DESIGN

Retrospective analysis of collected data.

SUBJECTS AND METHODS

Patients with chronic rhinosinusitis with or without nasal polyps who underwent endoscopic sinus surgery were recruited. Demographic information including age, gender, body mass index, smoke history, atopic status and asthma was collected. Disease severity was measured by the Lund-Mackay CT score and Sino-Nasal Outcome Test-22 score. Serum 25-hydroxyvitamin D3 was measured by enzyme-linked immunosorbent assay preoperatively.

RESULTS

Serum 25-hydroxyvitamin D3 levels were significantly lower in patients with nasal polyps (CRSwNP, 38.2 ± 9.1 nmol/L; CRSsNP, 48.94 ± 12.1 nmol/L; control, 54.1 ± 17.1 nmol/L. p < 0.001), and the levels were significantly associated with the preoperative Sino-Nasal Outcome Test-22 score (p = 0.013), but not with the Lund-Mackay score (p = 0.126). Furthermore, serum 25-hydroxyvitamin D3 levels were associated with the subjective improvement six months postoperatively (p < 0.001), CONCLUSION: Serum 25-hydroxyvitamin D3 levels are lower in Chinese CRSwNP patients. These 25-hydroxyvitamin D3 levels are associated with SNOT-22 score. Preoperative 25-hydroxyvitamin D3 level may impact on the symptom improvement after surgery.

Clinical features of IgG4-related rhinosinusitis

PURPOSE

IgG4-related disease is a systemic disease that affects various organs of the body. Aim of this study is to elucidate the clinical characteristics of IgG4-related rhinosinusitis.

MATERIAL AND METHODS

Clinical features, laboratory findings, radiological and endoscopic findings, associated disease, treatment and prognosis were retrospectively examined in 10 patients with IgG4-related rhinosinusitis.

RESULTS

The age was 59.1±11.3 years old and male-to-female ratio was 1:1. The chief nasal complaints were hyposmia (n=4), nasal obstruction (n=3), and nothing (n=3). Serum IgG4 levels were elevated in all patients and the value was 740.4±472.4mg/dl. Other IgG4-related diseases were associated in all 10 patients, including IgG4-related sialadenitis (n=6), IgG4-related dacryoadenitis (n=5), and autoimmune pancreatitis (n=5). Imaging findings on CT/MRI were obstruction of the way of elimination (n=10), thickening of the sinus mucous membrane (n=10), and fluid in the sinus (n=6). All of the cases had bilateral findings. Nasal endoscopic findings were chiefly deviated nasal septum (n=5), polyps (n=4), edema of the mucous membrane (n=3). Histologically, abundant infiltration of IgG4 positive plasma cell and lymphocyte and an elevated IgG4+/IgG+ cell ration was detected in all 8 patients and 5 patients, respectively. Endoscopic sinus surgery was performed in 8 patients. Eight patients were treated with steroid therapy for other associated IgG4-related diseases. Symptoms improved in all 6 patients after an initial treatment (endoscopic surgery (n=5) and steroids (n=1)), but one patient suffered relapse.

CONCLUSIONS

IgG4-related rhinosinusitis is a distinct entity of IgG4-related disease, and is associated in patients with multiple IgG4-related diseases.

Periostin: a novel biomarker for chronic rhinosinusitis

Periostin: a novel biomarker for chronic rhinosinusitis.

OBJECTIVES

Rhinosinusitis is characterized by inflammation of the sinuses, resulting in particular symptoms. This study aims to investigate the feasibility of periostin as a biomarker for chronic rhinosinusitis.

METHODOLOGY

The mucosal tissues of the ethmoid sinus were sampled from 12 patients with chronic rhinosinusitis without nasal polyps (CRsNP) and 25 with chronic rhinosinusitis with nasal polyps (CRwNP). Inferior turbinate biopsy was performed in 15 patients with a deviation of the nasal septum (DNS). Immunohistochemical (IHC) staining was performed to assess the distribution of periostin. Quantitative reverse transcription-polymerase chain reaction (RT-PCR) was conducted to detect the expression of periostin mRNA in nasal tissue specimens. The serum concentration of periostin was measured using enzyme-linked immunosorbent assay (ELISA). Correlation analysis among periostin mRNA in nasal mucosa, IHC staining score of periostin, serum concentration of periostin and proportion of blood eosinophils was performed.

RESULTS

The serum concentration of periostin and the IHC staining score of nasal mucosa from CRSsNP and CRSwNP patients were significantly higher than those in DNS counterparts (both P <0.01). The levels of periostin mRNA in CRSsNP and CRSwNP patients were slightly increased, but did not significantly differ from that in the DNS group (both P >0.05). The IHC staining score and serum concentration of periostin were correlated with the proportion of eosinophils in blood (P<0.05 and P <0.0 1).

CONCLUSION

Periostin can be used as a novel biomarker for chronic rhinosinusitis, which provides a potential target for individualized therapy of chronic rhinosinusitis.

Association of Vitamin D Status and Acute Rhinosinusitis: Results From the United States National Health and Nutrition Examination Survey 2001-2006

Although vitamin D status may be a modifiable risk factor for various respiratory ailments, limited data exists regarding its role in sinonasal infections. Our goal was to investigate the association of 25-hydroxyvitamin D (25OHD) levels with acute rhinosinusitis (ARS) in a large, nationally representative sample of non-institutionalized individuals from the United States. In this cross-sectional study of individuals ≥ 17 years from the National Health and Nutrition Examination Survey 2001-2006, we used multivariable regression analysis to investigate the association of 25OHD levels with ARS, while adjusting for season, demographics (age, sex, race, and poverty-to-income ratio), and clinical data (smoking, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and neutropenia). A total of 3921 individuals were included in our analyses. Median 25OHD level was 22 (interquartile range 16-28) ng/mL. Overall, 15.8% (95% confidence interval [CI] 14.4-17.7) of participants reported ARS within the 24 hours leading up to their survey participation. After adjusting for season, demographics, and clinical data, 25OHD levels were associated with ARS (odds ratio 0.88, 95% CI 0.78-0.99 per 10 ng/mL). When vitamin D status was dichotomized, 25OHD levels < 20 ng/mL were associated with 33% higher odds of ARS (odds ratio 1.33, 95% CI 1.03-1.72) compared with levels ≥ 20 ng/mL. Our analyses suggest that 25OHD levels are inversely associated with ARS. Randomized, controlled trials are warranted to determine the effect of optimizing vitamin D status on the risk of sinonasal infections.

Phenotype of asthma related with high serum periostin levels

BACKGROUND

Asthma is a heterogeneous disease composed of various phenotypes. Periostin, a molecule inducible with interleukin (IL)-4 or IL-13 in bronchial epithelial cells, is a biomarker of "TH2-high" asthma. The objective of this study is to examine whether the serum periostin concentrations are correlated with the severity, specific phenotype(s), or comorbidity of asthma.

METHODS

Serum concentrations of periostin were measured in 190 Japanese asthmatic patients and 11 healthy controls. The protocol was registered under UMIN 000002980 in the clinical trial registry.

RESULTS

The serum concentrations of periostin were significantly higher (P = 0.014) in asthmatics [70.0 (54.0-93.5) ng/ml] than in healthy subjects [57.0 (39.0-63.0) ng/ml], though we found no correlation between serum periostin concentrations and treatment steps required to control asthma. To characterize "high-periostin" phenotype(s), the patients with asthma were divided among tertiles based on the serum concentrations of periostin. The high-periostin group was older at onset of asthma (P = 0.04), had a higher prevalence of aspirin intolerance (P = 0.04) or concomitant nasal disorders (P = 0.03-0.001), higher peripheral eosinophil counts (P < 0.001), and lower pulmonary function (P = 0.02-0.07). The serum concentrations of periostin were particularly high in asthmatic patients complicated by chronic rhinosinusitis with nasal polyps and olfactory dysfunction. In contrast, neither atopic status, control status of asthma, nor quality of life were related with the "high-periostin" phenotype.

CONCLUSION

Elevated periostin concentrations in serum were correlated with a specific phenotype of eosinophilic asthma, late-onset and often complicated by obstructive pulmonary dysfunction and nasal disorders.

Evaluation of oxidative DNA damage and antioxidant defense in patients with nasal polyps

OBJECTIVES

The presence of inflammatory cells indicates the development of epithelial cell injury in nasal polyposis (NP) and the potential for production of high levels of reactive oxygen and nitrogen species. The aim of our study was to clarify the role of oxidative stress and antioxidant status in the deterioration accompanying NP.

METHODS

Twenty patients (11 men) aged 47.2 ± 17.0 years with nasal polyps were included in the study. Twenty healthy subjects (7 men) aged 48.2 ± 15.3 years formed the control group. The erythrocyte activities of antioxidant enzymes, superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx), and plasma nitric oxide (NO) concentrations were measured. An alkaline comet assay was used to determine the extent of blood lymphocyte DNA damage of oxidized purines as glicosylo-formamidoglicosylase (Fpg) sites, and oxidized pyrimidines as endonuclease III (Nth) sites.

RESULTS

A significant increase of NO (P < 0.05) and non-significant decreases of SOD (P > 0.05), CAT (P > 0.05), and GPx (P > 0.05) were seen in NP patients compared to healthy controls. The level of blood lymphocyte oxidative DNA damage in NP patients was significantly higher compared to the control group (P = 0.01).

DISCUSSION

The blood lymphocyte DNA damage level increased in patients with NP. Elevated DNA damage may be related to overproduction of reactive oxygen and nitrogen species and/or decreased antioxidant protection.

[The expression of interleukin-25 in blood and nasal tissue of patients with chronic rhinosinusitis with nasal polyps]

OBJECTIVE

To explore the expression of interleukin-25 (IL-25) in chronic rhinosinusitis with nasal polyps (CRSwNP) and its potential significance in pathogenesis.

METHOD

IL-25 expression in blood was detected by enzyme-linked immunosorbent assay (ELISA). IL-25 expression in tissue was detected by immunohistochemistry (LSAB method) from polyps (68 CRSwNP patients) and 55 inferior turbinate mucosa from patients with deviation of nasal septum served as control. Complete blood count and HE staining of blood and tissue eosinophil infiltration degree.

RESULT

IL-25 expression in CRSwNP group were significantly higher than the control group, the difference was statistically significant (P < 0.01). IL-25 expression in local organizations was positively correlated with the number of eosinophil infiltration in CRSwNP group (r = 0.679, P < 0.01).

CONCLUSION

The expression of IL-25 in CRSwNP patients mutually reinforcing and might increase eosinophil infiltration and play an important role in the development of CRSwNP.

[Rapid determination of cephalexin in biological media]

The behavior of cephalexin in pharmaceutical and biological media was studied by spectrophotometric method. The ranges of linearity and the limits of cephalexin detection were determined. The possibilities of spectrophotometric cephalexin determination in mixed saliva and in blood serum were shown. Optimal conditions of proteins precipitation were revealed. Pharmacokinetic parameters of cephalexin in oral fluid of patients with sinusitis were determined.

[Association analysis of sIgE, IgE, EOS and the occurrence of chronic rhinosinusitis with nasal polyps]

OBJECTIVE

To discuss the relation between total IgE, special IgE and Eosinophils of serum in blood and the occurrence of nasal polyps (NP) of chronic rhinosinusitis (CRS) patients, and then to get the best clinic index.

METHOD

One hundred and fifty two cases of CRS patients were divided into two groups (CRSsNP, CRSwNP). Allergen in vitro were screened, and then. the acidophilic granulocyte percentage and the total IgE of serum in blood were determined.

RESULT

(1) The IgE concentration of CRSsNP was mainly at one level while the IgE concentration of (CRSwNP was mainly at two or three levels (Z = 0.906, P > 0.05). There was no significant difference of sIgE serum between the two groups. (2) The EOS percentage of CRSwNP was distinctly higher than that of CRSsNP(F = 4.337, P = 0.039 t = 3.315, P < 0.01). The 95% confidential interval (CI) of EOS of CRSwNP was 3.90%-5.260, 5% TM value was 4.3, which were higher than the concentration of CRSsNP and normal val ue. There was no significant difference between different groups (classes) if the CRSwNP group were classified by sIgE concentration (P > 0.05). (3) CRSwNP patients were mainly mixed-type allergen allergy and the proportion of patients with this mixed-type allergen would increase in accordance with the increasing of allergen concentration gradient (chi2 = 8.595, P < 0.05).

CONCLUSION

The occurrence of CRSwNP is related to the increase of EOS and mixed allergens. When the concentration of EOS range from 3.90% to 5.26%, CRSwNP is more likely to occur. The concentration of total IgE and sIgE are not the risk factors singly. Allergen screening result combined with the clinical symptoms can help to get knowledge of and keep away from allergen, and also is beneficial to make treatment plan of perioperative period of CRS.

A role for anti-BP180 autoantibodies in chronic rhinosinusitis

OBJECTIVES/HYPOTHESIS

Chronic Rhinosinusitis (CRS) is accompanied by evidence of a vigorous adaptive immune response, and emerging studies demonstrate that some nasal polyps manifest a polyclonal autoantibody response. We previously found that antibodies against BP180, a component of the hemidesmosome complex and the dominant epitope in autoimmune bullous pemphigoid, were found at elevated levels in nasal polyp tissue. Given the critical role of hemidesmosomes in maintaining epithelial integrity, we sought to investigate the distribution of BP180 in nasal tissue and evaluate for evidence of systemic autoimmunity against this antigen in CRS.

STUDY DESIGN

Case-control experimental study.

METHODS

The expression and distribution of BP180 in cultured nasal epithelial cells and normal nasal tissue were confirmed using real-time polymerase chain reaction (PCR), Western immunoblotting, immunofluorescence and immunohistochemistry. Sera were collected from three groups: control, CRSsNP, and CRSwNP. A commercially available ELISA was utilized to compare anti-BP180 autoantibody levels in sera.

RESULTS

BP180 is expressed in nasal epithelium, but is not confined to the basement membrane as it is in human skin. In cultured nasal epithelial cells, confocal immunofluorescence showed a punctate distribution of BP180 along the basal surface, consistent with its distribution in epithelial keratinocytes. There are significantly higher levels of circulating nonpathologic anti-BP180 autoantibodies in CRS patients compared with normal controls (P <0.05).

CONCLUSIONS

BP180 is more widely expressed in nasal epithelium versus skin, although it appears to play a similar role in the formation of hemidesmosomes along the basement membrane. Further investigations are ongoing to characterize the pathogenicity of the anti-epithelial antibody response in CRS.

[The clinical significance of 1,3-beta-D glucanase detection in plasma to the diagnosis of fungal rhinosinusitis]

OBJECTIVE

To investigate the clinical significance of 1,3-beta-D glucanase detection in plasma to the diagnosis of fungal rhinosinusitis.

METHOD

MB-80 rapid microorganism detection system was used to detect preoperative and postoperative 1,3-beta-D glucanase in plasma of 37 patients of fungal rhinosinusitis which were treated by endoscopic sinus surgery and confirmed by postoperative pathology. Blood samples of 47 patients who underwent endoscopic surgery(fungal rhinosinusitis excluded) were taken as control group.

RESULT

1,3-beta-D glucanase content is more than 10 pg/ml in 34 cases of the fungal rhinosinusitis group,and every 1,3-beta-D glucanase content of 47 control cases is less than 10 pg/ml. Significant difference is found between case and control groups(chi2 = 72.6, P < 0.01).

CONCLUSION

1,3-beta-D glucanase detection in plasma is a simple,rapid diagnostic method of fungal rhinosinusitis.

[The activity of peroxidation of lipids in biologic samples of patients with recurrent diseases of upper respiratory tracts]

The parameters of peroxidation of lipids in blood and saliva were analyzed on sampling of 60 patients with recurrent diseases of upper respiratory tracts during period of remission. It is established that the content of primary and secondary products of peroxidation of neutral lipids in blood plasma is lower as compared with healthy persons. The content of end products of peroxidation of neutral lipids and products of oxidation of phospholipids in blood plasma is higher as compared with healthy persons. The characteristics of alterations of intermediates of peroxidation of lipids in various biologic samples depend on the localization of inflammatory process.

[The etiologic diagnostics of rhinosinusitis using clinical laboratory methods]

The examination was applied to 81 children aged 5-15 years, including 64 children with diagnosis of rhinosinusitis. The control group consisted of 17 healthy children. The set of laboratory clinical diagnostic techniques was applied to detect the causes of pathology. It is established that children with rhinosinusitis suffered from concurrent bacterial and virus infections. The morphologic presentation of mucous membrane of nasal cavity reflects the etiologic factor and the stage of inflammatory process. The detection of concentration of IL-4, IL-6 and IL-8 of blood serum gives a possibility to diagnose children with combined mechanisms of development of rhinosinusitis.

[The cytokine status as a criterion for the efficacy of intranasal aerosol therapy with the use of a cycloferon solution in the patients presenting with allergic rhinosinusitis]

The objective of the present study was to estimate the informative value of the variations in the levels of the principal cytokines for the evaluation of the efficacy of local immunotherapy in the immunocompromised individuals presenting with allergic rhinosinusitis (ARS). The study was focused on the analysis of the outcomes of the treatment with the use of a new highly effective therapeutic modality based on the intranasal administration of a cycloferon aerosol solution (125 mg/ml) used in allergologic practice. The main criterion for the efficacy of this treatment was variations of IL-4, IL-8, TNF-alpha, and interferon-gamma levels. The method for the measurement of concentrations of the principal cytokines may be recommended for the evaluation of the efficacy and prognosis of the treatment of allergic rhinosinusitis.

[A new technique for local immunotherapy of allergic rhinosinusitis--intranasal aerosol therapy with the use of a cycloferon solution]

The objective of this study was to estimate the clinical and immunological efficacy of local immunotherapy with the use of a cycloferon solution. The authors describe a new highly efficacious method for the treatment of allergic rhinosinusitis by means of the intranasal introduction of the cycloferon aerosol (125 mg/ml). A total of 79 patients presenting with this pathology were included in the study. Comparative evaluation of clinical and immunological efficiency of intranasal aerosol therapy using the cycloferon solution and its standard parenteral administration has demonstrated the high efficiency and safety of intranasal aerosol therapy in a group of immunocompromised patients with allergic rhinosinusitis. The study revealed correlation between clinical symptoms and characteristics of the patients' cytokine status which suggests the high informative value of measuring principle cytokine levels and especially their local fractions.

Characterization of specific antibody deficiency in adults with medically refractory chronic rhinosinusitis

BACKGROUND

Specific antibody deficiency may predispose patients to recurrent respiratory tract infections. There is limited literature assessing specific antibody deficiency in chronic rhinosinusitis (CRS). This study evaluated the role of specific antibody deficiency in patients with CRS who have failed medical therapy.

METHODS

We performed a retrospective chart review of patients with CRS who underwent functional endoscopic sinus surgery and had prior assessment for humoral immunodeficiency. Each patient's record was reviewed for serum quantitative immunoglobulin G (IgG) and IgA and anti-Streptococcus pneumoniae antibody titers measured at baseline and 6 weeks postvaccination with the 23-valent unconjugated pneumococcal vaccine. Clinical characteristics, including asthma, atopy, and nasal polyps, were recorded.

RESULTS

Of the 129 CRS patients who met inclusion criteria, 93 (72%) had low baseline antipneumococcal titers. Fifteen (11.6%) patients were diagnosed with specific antibody deficiency based on an inadequate response to the pneumococcal polysaccharide vaccine. The group of patients with specific antibody deficiency had significantly lower serum IgA levels when compared with those patients with normal preimmunization titers (138 ± 67.3 versus 330 ± 356; p < 0.05). Patients with specific antibody deficiency had a significantly lower number of preimmunization protective antipneumococcal titers when compared with vaccine responders (1.41 versus 2.72; p < 0.0005).

CONCLUSION

This retrospective study indicates that patients with medically refractory CRS may have a high prevalence of low preimmunization antipneumococcal titers and specific antibody deficiency. Furthermore, lower serum IgA levels identified in these specific antibody deficiency patients suggests that a prospective study to further characterize this relationship is warranted.

IgG4-related chronic rhinosinusitis: a new clinical entity of nasal disease

CONCLUSION

IgG4-related disease involves nasal manifestations with chronic rhinosinusitis (CRS). This type of sinusitis is a new clinical entity of nasal disease associated with a high level of serum IgG4 for which steroid therapy is effective. Objectives. To confirm whether IgG4-related disease has distinctive chronic rhinosinusitis.

METHODS

We compared serum IgG4 levels as well as nasal computed tomography (CT) and clinicopathological findings before and after glucocorticoid treatment in 31 patients diagnosed as having IgG4-related disease with nasal manifestations. To evaluate immunohistochemical findings of nasal mucosa, we compared them with IgG4-related CRS and common CRS.

RESULTS

All patients had levels of high serum IgG4. Ten of the 31 patients had nasal obstruction, nasal discharge, postnasal discharge, hyposmia, and dull headache. They also demonstrated sinus lesions on radiological findings. After glucocorticoid treatment, serum IgG and IgG4 levels were markedly decreased and along with improvement of the symptoms, nasal sinus CT findings also revealed improvement of the sinus opacification. In immunohistochemical examination, the magnitude of IgG4-positive plasma cell infiltration in common CRS was almost the same as in the IgG4-related CRS group. Therefore, in nasal mucosa immunocytochemical positive staining for IgG4 is not specific for definition of IgG4-related disease.

[Effect of cycloxygenase 2 inhibitor on levels of prostaglandin E2 in plasma and in local infiltrated fluid after functional endoscopic sinus surgery]

OBJECTIVE

To examine the time course and clinical relevance of changes in prostaglandin E2 (PGE2) to pain and outcome in surgical drainage, and circulating blood after functional endoscopic sinus surgery (FESS).

METHODS

Thirty-seven patients scheduled to undergo FESS were randomized to receive celecoxib 400 mg(n=16) one hour before anesthesia induction and celecoxib 200 mg, q12 h for five consecutive days after surgery or nothing for patients in control group(n=21). Surgical site drainage and venous blood were collected up to 48 hours after surgery to test PGE2 level. Plasma levels of thromboxane A2 (TXA2) and prostacyclin (PGI2) were also tested for the same time course.

RESULTS

For control patients, PGE2 level was elevated in both surgical site and circulating blood, which reached a peak concentration 6 h(177.5 ± 142.2 ng/L) and 48 h (64.5 ± 21.4 ng/L)respectively after FESS. For patients in celecoxib group, a significant reduction of surgical drainage PGE2(peak level 106.2 ± 33.4 ng/L at 6 h) and plasma PGE2 (peak level 44.7 ± 30.2 ng/L at 48 h) was observed(P<0.05). Pain scores 6 h and 48 h after surgery were positively correlated with surgical drainage PGE2 level, correlation coefficient being 0.333 (P=0.044) and 0.353(P=0.032) respectively. Celecoxib did not affect the ratio of plasma TXA2 to PGI2.

CONCLUSION

Upregulation of PGE2 in surgical site after surgery was crucial in inflammatory response and postoperative pain. Cycloxygenase-2 inhibitor could significantly reduce surgical drainage and plasma PGE2 concentration.

[Character of lipopolysaccharide-binding protein level changes in different pathological conditions and dysbiosis]

AIM

To evaluate diagnostic value of lipopolysaccharide-binding protein (LBP) level in different infectious processes and dysbiosis.

MATERIALS AND METHODS

Serum samples of patients with salmonellosis, urogenital chlamydiosis, community-acquired pneumonia, polypous rhinosinusitis, and bacterial vaginosis were studied.

RESULTS

LBP level were lower in patients with salmonellosis compared to healthy persons and decreased with increasing severity of the disease. Higher levels of LBP were detected in patients with chlamydiosis. Direct correlation between LBP level and etiology and severity of community-acquired pneumonia was demonstrated. In patients with polypous sinusitis, LBP level correlated directly with duration of disease, and inversely--with duration of remission. Twofold increase of mean LBP blood concentration and its correlation with duration of dysbiosis in patients with bacterial vaginosis were revealed.

CONCLUSION

Multidirectional modulation of antiendotoxin defense was observed in different pathological conditions.

[A clinical study on changes of EGF in serum before and after endoscopic surgery in patients with chronic sinusitis disease]

OBJECTIVE

To evaluate the changes of epidermal growth factor (EGF) in serum before and after endoscopic surgery in patients with chronic sinusitis, and then to explore its clinical significance.

METHOD

Serum was collected before and after operation and EGF concentrations were measured by the radioimmunoassay at different times.

RESULT

EGF levels in patients with chronic sinusitis (1.24 +/- 0.41) microg/L were higher than that in control group (0.92 +/- 0.23) microg/L, but there were no significantly difference between them (P > 0.05). The concentrations of EGF were reduced after surgery, and the lowest were evaluated after 4 weeks. Significant difference of EGF concentrations were found between before and 4 weeks after operation (P < 0.01). The concentration of EGF were raised 6 weeks after surgery, and returned to normal after 8 weeks.

CONCLUSION

The changes of EGF in serum before and after endoscopic surgery may relate with the epithelization process of sinus mucosa after endoscopic surgery.

[Serum levels of IL-12, IL-4 and pathologic changes by scanning electron microscope of nasal mucous inflammation]

OBJECTIVE

The serum levels of interleukin-4, interleukin-12 will be detected to elucidate and compare the involvement of Th1 and Th2 cells and the surface structures of nasal mucosa will also be observed in patients with allergic rhinitis (AR), chronic rhinosinusitis with nasal polyps (CRSwNP), chronic rhinosinusitis without nasal polyps (CRSsNP) and nasal septal deviation (NSD) to obtain the characteristics and regularity of pathological changes.

METHOD

The serum levels of interleukin-4, interleukin-12 were detected by enzyme linked immunosorbent assay method. Four pieces of nasal mucosa on lateral side of middle turbinate were sampled from four patients and observed by scanning electron microscope.

RESULT

The levels of interleukin-4 in AR and NSD groups were significantly higher than the healthy controls (P < 0.01). The levels of interleukin-4 and interleukin-12 in CRSwNP and CRSsNP groups were both higher than the healthy controls (P < 0.01 or P < 0.05), but no differences of the interleukin-4 and interleukin-12 levels were found between them (P > 0.05). There were two points of regularity with different degrees in our observations: (1) disoriented and absence of cilium; (2) the cellular separations at cell junctions were obvious, even with cells lost.

CONCLUSION

There was an immunologic deviation towards Th2 pattern in patients with NSD the same as AR. Both Th1 and Th2 with hyperactivity participated in chronic inflammatory process of CRSwNP and CRSsNP. The pathological changes of ciliated columnar epithelium in patients with the four types of rhinitis, suggest that a comprehensive treatment including antral irrigations, multiple antibiotics, topical steroid sprays, or antihistamines, as well as nasal surgery to correct nasal deformities should be adopted, which can effectively prevent the development and expanding of the nasal mucosa inflammation.

Risk stratification of severe acute rhinosinusitis unresponsive to oral antibiotics

CONCLUSIONS

C-reactive protein (CRP) levels may predict the extent of acute rhinosinusitis disease in the computed tomography (CT) scans, as well as the specific symptom severity. High levels may direct the physician to change the treatment.

OBJECTIVE

To establish tools to define 'high risk' patients suffering from acute rhinosinusitis.

METHODS

Patients suffering from severe unresponsive acute rhinosinusitis filled in health-related quality of life questionnaires and rated their symptoms. Blood tests and CT scans were performed. We examined the value of imaging and inflammatory markers, especially CRP, as predictors of disease severity, defined by subjective and objective means; need for surgery; and occurrence of ocular complications.

RESULTS

Thirty-two patients were prospectively recruited. A significant association was found between CRP levels, imaging scores, and symptoms severity. Neither ocular complications nor the need for surgery were present in the group with low CRP level.

Migration of regulatory T cells toward airway epithelial cells is impaired in chronic rhinosinusitis with nasal polyposis

The pathogenesis of chronic rhinosinusitis with nasal polyposis (CRSwNP) is still unclear. To evaluate the role of regulatory T cells (Treg) in the pathogenesis of nasal polyposis, we tested migration potential of Treg purified from subjects with CRSwNP, CRS without NP and controls. The nasal tissue expressions of FOXP3 were analyzed by means of RT-PCR and double immunohistochemistry. Chemotaxis assays were used to evaluate the migration potential of Treg onto bronchial epithelial cells and primary nasal epithelial cells, and toward chemokines. FOXP3(+)CD3(+) cells frequency and FOXP3 transcript expression in nasal tissue, and migration potentials of Treg toward airway epithelial cells and CCL1 were significantly lower in CRSwNP compared with other groups (P<0.05). These results indicate that migration potential of Treg is decreased in CRSwNP subjects, and this may be one of the reasons why tissue infiltration of Treg was decreased as seen in the immunohistochemistry of nasal polyps from CRSwNP subjects.

[The relationship between eosinophilia and parameters of systemic and local adaptive immunity in patients with polypous rhinosinusitis]

Results of the study on adaptive immunity in patients with polypous rhinosinusitis (PRS) proved to depend on the degree of eosinophilia in the peripheral blood. The patients were allocated to two groups, one comprised of those having up to 150 eosinophils per 1 microliter the other of the patients with a higher eosinophil concentration. Patients of the former group had a significantly reduced number of CD3+, CD4+, CD8+, and CD20+cells in the peripheral blood that may indicate the necessity of administering immunotropic agents. The opposite picture is characteristic of the latter group in which a rise in the number of the above cells is associated with the increased amount of IgG- and IgA-positive cells. In this situation, the use of systemic immunotropic agents should be restricted. It is concluded that evaluation of systemic and local adaptive immunity is of importance for the choice of an adequate strategy for the treatment of patients with polypous rhinosinusitis.

Increased serum complement component 3 and mannose-binding lectin levels in adult Chinese patients with chronic rhinosinusitis

OBJECTIVE

To study the immune function of adult Chinese patients with chronic rhinosinusitis (CRS) to elucidate its potential role in the pathogenesis of CRS.

METHODS

A prospective three-arm case-control study. The study population comprised 72 CRS patients without nasal polyps (NPs), 95 CRS patients with NPs, and 110 healthy controls. The concentrations of serum immunoglobulin A (IgA), M (IgM), G (IgG), IgG subclasses (IgG1-4), complement component 3 (C3), and complement component 4 (C4) were measured by nephelometry. Serum mannose-binding lectin (MBL) levels were analyzed by enzyme-linked immunosorbent assay. All CRS patients had a complete blood count with differential, atopic status evaluation, coronal computed tomographic (CT) scan of the sinuses, and nasal endoscopy.

RESULTS

Frequency of immunoglobulin, C3, C4, or MBL deficiency showed no difference among groups. The prevalence of coexistence of MBL and immunoglobulin or complement component deficiency did not differ significantly among groups either. However, compared with controls, decreased IgG3 levels were found in CRS patients without NPs, and increased C3 and MBL levels was found in both CRS patients with and without NPs. Moreover, MBL levels were significantly higher in CRS patients with NPs than in CRS patients without NPs, which positively correlated with extent of disease seen on CT scan and endoscopy, and peripheral eosinophil count.

CONCLUSIONS

Immunoglobulin, C3, C4, and MBL deficiency is not the main cause of CRS in adult Chinese patients. However, on the contrary, increased C3 and MBL levels in serum might play a modulatory role in CRS development.

[Effect of allergy on outcomes after endoscopic sinus surgery in patients with chronic rhinosinusitis]

OBJECTIVE

To explore correlation of allergy and outcomes after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis.

METHOD

Before ESS, 115 cases were arranged to detect allergic serum relative index: the concentration of serum TIgE, specific IgE semi-quantitative test and the concentration of serum ECP; to survey QOL status: VAS, SNOT-20 and SF-36; as well as inquire medical record, Lund-Mackay CT system scoring, clinical classification of chronic rhinosinusitis. After ESS (>1 year), 74 cases were followed up. The subjective and objective assessment were achieved by means of VAS, SNOT-20, SF-36 and Lund-Kennedy endoscopic scores.

RESULT

The improvements of VAS scores of the cases with increased serum TIgE were significantly lower than those without increased serum TIgE (P<0.05). In cases of II, III types, the objective outcomes of the cases with increased serum TIgE were significantly worse than those without increased serum TIgE (P<0.05). The objective outcomes of the cases with positive allergen (> or = 3) were significantly worse than those with positive allergen (<3) (P<0.05). The objective outcomes of the cases with strong positive allergen were significantly worse than those without strong positive allergen (P<0.05). VAS scores and SNOT-20 scores after endoscopic sinus surgery of the cases with strong positive allergen were significantly worse than those without strong positive allergen (P<0.05). The concentration of serum ECP of the invalid cases was significantly higher than effective cases (P<0.05). The concentration of serum ECP was positive correlated with Lund-Kennedy endoscopic scores (r=0.49, P<0.05). In cases of II, III types, the objective outcomes of the cases with increased serum ECP were significantly worse than those without increased serum ECP (P<0.05), VAS scores and SNOT-20 scores after endoscopic sinus surgery of the cases with increased serum ECP were significantly worse than those without incre- ased serum ECP (P<0.05), the improvements of VAS scores of the cases with increased serum ECP were significantly lower than those without increased serum ECP (P<0.05).

CONCLUSION

Those allergic serum relative indexes make some negative effect on subjective and objective outcomes. Especially, in cases with polyps, the increase of serum TIgE and serum ECP has more negative effect. Our results might help to choose immunotherapy to combine with endoscopic sinus surgery for those selected patients to improve the outcomes of chronic rhinosinusitis.

[Clinicopathologic evaluation of 36 cases of allergic fungal sinusitis]

OBJECTIVE

To characterize clinicopathological features of allergic fungal sinusitis (AFS).

METHODS

Thirty-six cases of AFS were retrieved from the department archival files of Beijing Tongren Hospital from 2002 to 2006. AB-PAS, GMS and MUC5B stain were performed using paraffin-embedded tissues of the cases. Ten cases with available fresh diagnostic tissue were investigated by electron microscopy.

RESULTS

Patients included 21 males and 15 females. The age of patients ranged from 11 to 53 years. Atopy was very common in these patients. On plain CT scans, the affected nasal sinuses were filled with soft tissue shadow with patchy hyperdensity. The bony sinus wall showed areas of pressure erosion. Skin antigen tests showed fungal positivity in 31 of 36 cases. Serum levels of the total IgE and/or the specific fungal IgE were elevated in 20 cases. The eosinophil quantity was elevated in 23 cases. Fungal culture was positive in 10 cases. Gross examination showed thick putty secretions within the lesions. Light microscopy showed typical "eosinophilic mucin". Fungal elements were seen with AB-PAS, GMS and MUC5B stains. Electron microscopy demonstrated degranulation by the eosinophils.

CONCLUSIONS

"Eosinophilic mucin" is the typical histopathological feature of AFS. AB-PAS, GMS and MUC5B staining methods can used to detect fungal species in mucin. Accurate diagnosis of AFS requires correlations among clinical findings, radiologic examinations, laboratory tests and histopathologic features. However, the ultimate diagnosis requires a histopathologic confirmation.

Characterizing T-cell phenotypes in nasal polyposis in Chinese patients

BACKGROUND

Nasal polyposis has different etiologies in Western and Eastern countries. Furthermore, its pathogenesis is still poorly understood.

OBJECTIVE

To determine the T-cell phenotypes involved in nasal polyposis in Chinese patients.

METHODS

Twenty-four Chinese patients with nasal polyps were studied. CD4, CD8, Foxp3, and interleukin (IL) 17 were analyzed by immunohistochemical staining. Expression of T-bet, GATA-3, Foxp3, and RORgammat mRNA was detected by real-time polymerase chain reaction. The levels of T-cell cytokines (IL-4, IL-5, interferon [IFN] gamma, IL-10, IL-17, and transforming growth factor [TGF] beta) were determined using enzyme-linked immunosorbent assay, and serum immunoglobulin (Ig) E levels were measured using the UNICAP system.

RESULTS

Increased expression of CD4+ and CD8+ and decreased expression of Foxp3 and IL-17 were detected in nasal polyps compared with control tissue. Furthermore, expression of T-bet and GATA-3 mRNA was upregulated, whereas Foxp3 mRNA expression was markedly downregulated. Furthermore, increased levels of IFN-gamma, IL-4 and IL-5 and decreased levels of IL-10 and TGF-beta were found in nasal polyps. There was no association between Staphylococcus aureus exotoxin (SAE)-specific IgE and T regulatory cell (Treg) insufficiency in nasal polyps.

CONCLUSIONS

Our findings demonstrate that excessive infiltration of CD4+ and CD8+ T cells in nasal polyps may be associated with expression of Foxp3+ by Tregs but not with SAEs in Chinese patients.

Safety of budesonide in saline sinonasal irrigations in the management of chronic rhinosinusitis with polyposis: lack of significant adrenal suppression

OBJECTIVE

To evaluate the potential for hypothalamic-pituitary-adrenal (HPA) axis suppression by budesonide nasal irrigations in the treatment of refractory chronic rhinosinusitis with polyposis (CRSwP).

STUDY DESIGN

Retrospective, descriptive review of patient charts.

SETTING

Tertiary care rhinology practice in an academic teaching hospital.

PATIENTS

Eighteen adult subjects with CRSwP refractory to conservative medical therapy.

METHODS

The charts of consecutive patients identified as being treated with topical budesonide in saline for nasal irrigation from January to October 2006 were reviewed. In all cases, pre- and posttreatment morning cortisol levels had been measured following at least 8 weeks of uninterrupted therapy. In addition, a subset of patients who continued therapy longer than 8 weeks had undergone the more sensitive adrenocorticotropic hormone (ACTH) stimulation test.

RESULTS

All pre- and posttreatment morning cortisol levels were within the normal range. For an 8-week treatment period, there was no evidence of HPA axis suppression (p=.4171). For patients who continued treatment beyond 8 weeks, ACTH stimulation did not detect HPA axis suppression. Furthermore, there were no issues with compliance or acceptability, nor were any adverse side effects reported.

CONCLUSION

Budesonide in saline sinonasal irrigation for the treatment of refractory CRSwP does not cause HPA axis suppression. The efficacy of this higher dose of steroid delivered locally would benefit from further study.

Systemic absorption of topical gentamicin sinus irrigation

OBJECTIVE

Evidence surrounding systemic absorption of gentamicin during intraoperative irrigation of the paranasal sinuses is lacking. The objectives of this study were to determine (1) if topical gentamicin is absorbed from the paranasal sinuses, (2) if hearing loss occurs following topical administration of gentamicin, and (3) if gentamicin placed within the sinuses travels retrograde (against mucociliary clearance) up the auditory tube to the middle ear.

DESIGN

Consecutive, prospective case series.

SETTING

Tertiary centre.

METHODS

A series of patients undergoing sinus surgery were identified. Fluorescein-stained gentamicin was used to irrigate the sinus cavities intraoperatively. Otoscopy using a filtered light source was performed 30 minutes postoperatively.

MAIN OUTCOME MEASURES

(1) Serum gentamicin levels preirrigation and at 30 minutes postirrigation and (2) change in pure-tone average and threshold at 8 kHz pre- and postoperative audiograms.

RESULTS

Twenty patients were enrolled. Serum gentamicin levels were detectable in three patients. Fluorescein irrigation solution was not visualized in the middle ear space. No significant hearing loss was observed in any of the patients.

CONCLUSIONS

Gentamicin may be absorbed from the nasal mucosa during intraoperative irrigation of the sinuses. However, detectable serum levels were well below therapeutic levels. The clinical significance of this finding requires further study to determine if topical sinus irrigation with gentamicin is a safe procedure.

[Effect of allergic factors on chronic rhinosinusitis]

OBJECTIVE

To explore the correlation between allergic factors and chronic rhinosinusitis, and discuss its effects on the development of illness.

METHOD

One hundred and one cases were selected to detect allergic serum relative index: the concentration of serum TIgE, specific IgE semi-quantitative test, the concentration of serum ECP as well as inquiring medical record, Lund-Mackay CT system scoring.

RESULT

The concentration of serum TIgE and serum ECP in CRS was higher than those in control (P < 0.01). The increased proportion of serum TIgE and serum ECP was significantly different among clinical stages (P < 0.05) and between the cases with and without prior sinus surgery (P < 0.05). CT scores of the cases with serum TIgE and serum ECP increased were significantly higher than those without serum TIgE and serum ECP increased. The strong positive rate in CRS was significantly different among clinical stages (P < 0.05). The strong positive rate increased significantly in the cases with prior sinus surgery (P < 0.05). CT scores in the cases with strong positive allergen were significantly higher than that in the cases without positive allergen (P < 0.05).

CONCLUSION

These results suggest that allergic factors make some negative effect on the severity of CRS and are the index for the severity and worse prognosis of illness.

Response of Peripheral Blood Lymphocytes to Fungal Extracts and Staphylococcal Superantigen B in Chronic Rhinosinusitis

BACKGROUND

Previous studies have suggested that chronic rhinosinusitis may result from a hypersensitivity response of the nasal mucosa to the presence of fungal antigens or staphylococcal superantigens in the nasal mucus. Both of these groups of antigens are present so frequently in the nasal mucus of patients with chronic rhinosinusitis that their presence together is likely to be a common event.

OBJECTIVE

The objective of this study was to determine whether the combined presence of fungal antigens and staphylococcal superantigens exert a synergistic proinflammatory effect on peripheral blood lymphocytes from patients with chronic rhinosinusitis.

METHODS

Peripheral blood lymphocytes were extracted from patients with chronic rhinosinusitis with and without nasal polyposis (n = 7 for both groups) and normal controls (n = 7). These cells were cultured for 48 hours after the addition of fungal extracts (Aspergillus and Alternaria), staphylococcal superantigen type B (SEB), or a combination of these two antigens. Real-time polymerase chain reaction was used to determine the level transcription of interleukinL-5 and interferon-gamma genes.

RESULTS

Fungal extracts alone resulted in minimal changes in the levels of cytokine expression in peripheral blood lymphocytes. SEB increased the expression of IFN-gamma, and this effect was magnified by the addition of SEB and fungal extracts together to the culture medium. There were no differences in the magnitude of responses seen in patients with and without polyps nor between patients with chronic rhinosinusitis and normal controls.

CONCLUSION

SEB exerts a powerful proinflammatory effect on peripheral blood lymphocytes and fungal extracts may act synergistically to promote this action.

Relationship between extremely low total serum IgE levels and rhinosinusitis

BACKGROUND

The few studies examining clinical manifestations in adults with serum IgE levels less than 2.0 IU/mL provide conflicting information.

OBJECTIVE

To examine self-reported respiratory disease in women with total serum IgE levels less than 2.0 IU/mL to further elucidate previous reports of an association between IgE deficiency and chronic rhinosinusitis.

METHODS

In a geographically based cohort of 626 pregnant women, total serum IgE levels were measured using a standard assay with a lower limit of detection of 2.0 IU/mL. Sera with IgE levels less than 2.0 IU/mL were assayed again using a low IgE protocol with a detection limit of 0.02 IU/mL.

RESULTS

Twenty-one individuals (3.4%) were found to have IgE levels less than 2.0 IU/mL. On repeated assay, 20 of these individuals with available clinical data were found to have detectable IgE levels ranging from 0.5 to 2.1 IU/mL (geometric mean, 1.2 IU/mL). None of these individuals with low IgE levels had physician-diagnosed sinusitis compared with 19.3% (113/585) of those with IgE levels of 2.0 IU/mL or greater (P = .03). Physician-diagnosed asthma was also less prevalent (1/19, 5.3%) in the low IgE group compared with 20.6% in those with higher IgE levels, but this was not significant (P = .14). The low IgE group reported a higher prevalence of hay fever symptoms than the remaining cohort (31.6% vs 24.4%; P = .43) but had less physician-diagnosed hay fever (5.3% vs 15.8%; P = .34).

CONCLUSIONS

Low serum IgE levels were relatively common in these pregnant women. In contrast to previous studies, a low IgE level was not associated with chronic rhinosinusitis.

[The perioperative glycemic control in chronic rhinosinusitis coexisting diabetes]

OBJECTIVE

To evaluate the method of the perioperative blood glucose control in chronic rhinosinusitis coexisting diabetes.

METHOD

Twenty-two cases of chronic rhinosinusitis coexisting diabetes were investigated retrospectively, including one case of type 1 diabetes and 21 cases of type 2 diabetes. The study cohort was divided into two groups, the one was complication group and the other was non-complication group. The patients in complication group were injected insulin to control blood glucose level, and the patients in non-complication group were prescribed oral medicine.

RESULT

Blood glucose levels below 9.0 mmol/L in complication group and below 7.0 mmol/L in non-complication group were both the surgical indication for the patients in this research cohort. Twenty-one cases were completely recovered and one case made progress significantly.

CONCLUSION

The detection of blood and urine glucose levels must be the routine item before the nasal endoscopic surgery. To control blood glucose levels in type 2 diabetes with non-complication, oral medicine is the first choice, in type 1 diabetes and type 2 diabetes with complication, insulin should be first considered.

Point of care testing for C-reactive protein - a new path for Australian GPs?

BACKGROUND

New approaches are needed to reduce antibiotic usage in respiratory tract infections in general practice without compromising patient safety. Point of care tests for C-reactive protein (CRP) are now being used for this purpose in some European countries.

OBJECTIVE

Current knowledge about the CRP response in respiratory tract infections is presented, as well as the usefulness of applying the test when sinusitis and pneumonia may be suspected.

DISCUSSION

A promising ability of the test in ruling in or out severe infection has been demonstrated in clinical studies. There are still controversies about the use of the CRP test in respiratory tract infections, however clinical research supports its use for some conditions, and therefore introduction into Australian general practice should be considered. Further evaluation of its utility is needed.

Expression of eicosanoid receptors subtypes and eosinophilic inflammation: implication on chronic rhinosinusitis

Background

Eicosanoid receptors are G-protein-coupled receptors playing an important immunomodulatory role in airway diseases. However, there is little information on the expression of these receptors and their link with eosinophilic inflammation in paranasal sinus diseases. We aimed with this study to investigate the tissue expression of leukotrienes and prostaglandin E2 receptors in chronic rhinosinusitis patients and the link of this regulation with eosinophilic inflammation.

Methods

Samples were prepared from nasal tissue of patients with chronic rhinosinusitis without nasal polyps (CRS, n = 11), with nasal polyps (CRS-NP, n = 13) and healthy subjects (Controls, n = 6). mRNA expression of CysLT₁, CysLT₂, BLT₁, BLT₂, E-prostanoid receptors (EP₁, EP₂, EP₃, EP₄) and sol-IL-5Rα was determined by real-time PCR. Concentrations of PGE2, LTC4/D4/E4, LTB4 and sol-IL-5Rα were determined by ELISA and of ECP by ImmunoCap. Protein expression and tissue localization of eicosanoid receptors and activated eosinophils were evaluated by immunohistochemistry.

Results

CysLT₁ mRNA expression was significantly increased in CRS-NP compared to CRS and controls, and CRS compared to controls, whereas CysLT₂ mRNA was enhanced in both CRS groups without differences between them. Levels of both receptors correlated to the number of activated eosinophils, sol-IL-5Rα, ECP and LTC₄/D₄/E₄ concentrations in the disease groups. PGE₂ protein concentrations and prostanoid receptors EP₁ and EP₃ were down-regulated in the CRS-NP tissue vs. CRS and controls, whereas EP₂ and EP₄ expression was enhanced in CRS and CRS-NP patients vs. controls. No differences in BLT receptors were observed between patients and controls.

Conclusion

CyLTs receptors are up-regulated in nasal polyp tissue and their expression correlate with eosinophilic inflammation supporting previous results. Eicosanoid receptors mRNA pattern observed suggests that down-regulation of EP₁ and EP₃ in CRS-NP and up-regulation EP₂ and EP₄ in CRS and CRS-NP groups may have some role in the development of the diseases and their regulation may not be directly linked to eosinophil activation but involve post-transcriptional events mainly related to other inflammatory cell sources.

[The expressions of serum TIgE and SIgE in patients with noninvasive fungal sinusitis and their significance]

OBJECTIVE

To investigate the expressions of serum TIgE and SIgE in patients with noninvasive fungal sinusitis and their significance.

METHOD

Twenty-three cases of noninvasive fungal sinusitis were analysis retrospectively. The expressions of serum TIgE and SIgE were detected by the Unicap system. The expressions of serum TIgE and SIgE in the subtypes of noninvasive fungal sinusitis were analysis statistically.

RESULT

Positive expressions of serum TIgE and SIgE in 23 cases were 10 cases (43%) and 7 cases (30%) respectively. In 14 cases of fungal ball, the positive expressions of serum TIgE and SIgE were 2 cases (14%) and 1 case (7%) respectively. In 9 cases of allergic fungal sinusitis,the positive expressions were 8 cases (89%) and 6 cases (67%) respectively. The different expressions of serum TIgE and SIgE between the two subtypes of noninvasive fungal sinusitis were statistically significant (P < 0.05).

CONCLUSION

In noninvasive fungal sinusitis, the detection of the expressions of serum TIgE and SIgE is an available way to distinguish the type of allergic fungal sinusitis from the type of fungal ball,and so it would be helpful to guide the treatment.

[Nitric oxide as indicator of paranasal sinusitis]

Squamous cell carcinoma antigen (SCCAg) is one of the most common markers used in diagnosis of head and neck cancer and larynx cancer. We tested correlations between level of SCC Ag and tumor size, presence of lymph node metastasis, clinical advances of tumour and histopathological diagnosis. Pretreatment level of SCC antigen was evaluated in 34 patients with squamous cell carcinoma of the larynx. Microparticle enzyme immunoassay was used to measure the SCCAg level. Elevated SCCAg serum levels were found in 41% of patients. The magnitude of the marker elevations were correlated with lymph node metastases (N0 versus N2, and N1 versus N2). Our date indicate that in patients with larynx cancer SCCAg does not appear to be a sensitive marker in the primary diagnosis. However, seem to be useful marker for monitoring nodal invasion.

Chronic sinusitis: defective T-cells responding to superantigens, treated by reduction of fungi in the nose and air

In this study, the author used endoscopic sinus photography to study the effects of reduction of fungi in the nose, and in environmental air, on the sinus mucosa of 639 patients diagnosed with chronic rhinosinusitis. Sinus mucosal photographs were taken before and after reduction of fungal load in the nose and air, to determine if there was an optimum environmental air fungal load associated with sinus mucosal recovery to normal appearance. Systemic symptoms associated with fungal exposure, which resolved when fungus was removed from the patient and the environmental air and reappeared with recurrent environmental fungal exposure, are also discussed and are termed systemic fungal symptoms. Interventions consisted of nasal fungal load reduction with normal saline nasal irrigations and antimicrobial nasal sprays, and environmental air fungal load reduction with high-efficiency particulate air (HEPA) filtration in combination with ionizers or evaporation of a solution of botanical extract. Main outcome measures were obtained with environmental air 1-hr gravity-plate fungal colony counts, laser air particle counts, and endoscopic sinus photography. Blood levels of immunoglobulins IgG and IgE for 7 common molds were also determined. After intervention, 94% of patients who used antimicrobial nasal sprays and who reduced their environmental fungal air count to 0-4 colonies per 1-hr agar gravity-plate exposure (n = 365) exhibited normal sinus mucosa by endoscopic exam. Environmental air fungal counts that exceeded 4 colonies resulted in sinus mucosal abnormalities ranging from edema, to pus and/or nasal polyps at higher counts. Neutralization of allergy, and/or surgery, were used as appropriate following implementation of environmental measures. On the basis of these observations, as well as detailed clinical experience and a review of the current literature, the author hypothesizes that the pathogenesis of chronic rhinosinusitis, allergic fungal sinusitis, and systemic fungal symptoms is a genetic defect at the variable beta chain helper T-cell receptor (TCR Vbeta) site which requires the presence of an antigen (fungus). Chronic sinusitis patients who have recurring exposure to environmental air that contains fungal concentrations in excess of 4 colonies per 1-hr agar plate exposure appear to have an increased risk of persistent chronic sinusitis and/or systemic symptoms, regardless of the medical treatment provided.

Serum levels of antioxidant vitamins, copper, zinc and magnesium in children with chronic rhinosinusitis

Reactive oxygen species including hydroxyl radicals, superoxide anions and hydrogen peroxide which are produced by activated granulocytes play an essential role in many biochemical processes and diseases. Oxidant-mediated tissue damage may be important in the development of chronic sinusitis. The aim of this study was to investigate the serum levels of antioxidant vitamins and elements in 24 children (14 boys and 10 girls, age range: 7-12 years, mean age: 9.2 years) with chronic rhinosinusitis, compared to 20 age and sex matched healthy children. Blood samples were collected in the morning before breakfast and prior to any medication. Vitamin A, E and C levels were determined using reagent kits for high performance liquid chromatography. Cu, Zn and Mg levels were analyzed by atomic absorption spectrometry. Vitamin E, vitamin C, Cu and Zn levels were significantly lower in the patients group than in the control group. However, vitamin A and Mg levels did not differ. In conclusion, serum levels of antioxidant vitamins and elements may be important in the pathogenesis and treatment of chronic rhinosinusitis in children.

[Efficacy of noninvasive hemolaserotherapy in patients with bronchial asthma and concomitant rhinosinusitis]

AIM

To study efficacy of low-intensive infrared laser radiation impact on the tympanic membrane in patients with bronchial asthma (BA) and concomitant rhinosinusitis (RS).

MATERIAL AND METHODS

78 patients with moderate BA of a mixed type and concomitant chronic RS were divided into 3 groups: group 1 patients received medication plus infrared laser radiation of the tympanic membrane and paranasal sinuses; group 2 patients were exposed to supravenous laser radiation (0.63 mcm); group 3 received pharmacotherapy alone. The effect of the treatment was assessed by spirometry, peakflowmetry and paranasal sinuses findings.

RESULTS

The highest response was achieved in group 1 which manifested with positive changes in clinical, device and spirometric data on BA and x-ray data on RS courses. The least effective treatment was observed in group 3.

CONCLUSION

Use of infrared laser radiation of the tympanic membrane and paranasal sinuses projection in the treatment of BA patients with RS is effective, nontoxic and easy to use both in hospitals and outpatient departments.

The role of interleukin-12, and tissue antioxidants in chronic sinusitis

BACKGROUND

The role of cytokines and reactive oxygen species formation in the pathogenesis of chronic sinusitis is still not fully understood. This work was designed to determine if patients with chronic sinusitis demonstrate altered levels of serum IL-12 and/or tissue antioxidants.

SUBJECTS AND METHODS

Mucosal biopsy specimens from the uncinate process of patients with chronic sinusitis were obtained from 52 patients using functional endoscopic sinus surgery. Normal mucosa samples were collected from 20 healthy controls. Patients' group was further classified according to computerized tomography findings into mild and severe subgroups. Serum IL-12 was estimated using enzyme immunoassay (EIA). The levels of tissue uric acid, and reduced glutathione were determined biochemically, alpha-tocopherol was measured by HPLC. Superoxide dismutase (SOD) activity was determined by spectrophotometry.

RESULTS

A significant decrease in serum IL-12, tissue alpha-tocopherol and SOD in patient group was demonstrated (p < 0.05). Tissue uric acid and reduced glutathione showed primary increase in mild subgroup followed by significant drop in severe subgroup (p < 0.05). Negative significant correlation was observed between glutathione, uric acid, and SOD, and the severity of the disease (p < 0.05) independent of the cellularity of the biopsy.

CONCLUSION

The presented data suggests a possible role of IL-12, and tissue antioxidants in development and progression of chronic sinusitis. Adjuvant antioxidant treatment may have role in achieving better prognosis of the disease.