Chinese Expert Consensus on the Use of Biologics in Patients with Chronic Rhinosinusitis (2022, Zhuhai).

BACKGROUND: Chronic rhinosinusitis (CRS) is a common inflammatory disease in otolaryngology, mainly manifested as nasal congestion, nasal discharge, facial pain/pressure, and smell disorder. CRS with nasal polyps (CRSwNP), an important phenotype of CRS, has a high recurrence rate even after receiving corticosteroids and/or functional endoscopic sinus surgery. In recent years, clinicians have focused on the application of biological agents in CRSwNP. However, it has not reached a consensus on the timing and selection of biologics for the treatment of CRS so far. SUMMARY: We reviewed the previous studies of biologics in CRS and summarized the indications, contraindications, efficacy assessment, prognosis, and adverse effects of biologics. Also, we evaluated the treatment response and adverse reactions of dupilumab, omalizumab, and mepolizumab in the management of CRS and made recommendations. KEY MESSAGES: Dupilumab, omalizumab, and mepolizumab have been approved for the treatment of CRSwNP by the US Food and Drug Administration. Type 2 and eosinophilic inflammation, need for systemic steroids or contraindication to systemic steroids, significantly impaired quality of life, anosmia, and comorbid asthma are required for the use of biologics. Based on current evidence, dupilumab has the prominent advantage in improving quality of life and reducing the risk of comorbid asthma in CRSwNP among the approved monoclonal antibodies. Most patients tolerate biological agents well in general with few major or severe adverse effects. Biologics have provided more options for severe uncontrolled CRSwNP patients or patients who refuse to have surgery. In the future, more novel biologics will be assessed in high-quality clinical trials and applied clinically.

Establishment and validation of M1 stage subdivisions for de novo metastatic nasopharyngeal carcinoma to better predict prognosis and guide treatment.

BACKGROUND: To better manage patients with de novo metastatic NPC (mNPC) including easily identifying individuals' survival outcomes and accurately choosing the most suitable treatment. MATERIALS AND METHODS: Three independent cohorts of mNPC patients (a training set of n = 462, an internal prospective validation set of n = 272 and an external prospective validation set of n = 243) were studied. The radiological characteristics of distant metastases, including number of metastatic locations, number of metastatic lesions and size of metastatic lesions, were carefully defined based on imaging data. These three factors and other potential prognostic factors were comprehensively analysed and were further integrated into new subdivisions of stage M1 using a Cox proportional hazards model. RESULTS: We successfully subdivided the M1 stage into three categories: M1a, oligo metastasis without liver involvement; M1b, multiple metastases without liver involvement; and M1c, liver involvement irrespective of metastatic lesions. The 3-year overall survival ranged from 54.5% to 72.8%, from 34.3% to 41.6% and from 22.6.0%-23.6% for M1a, M1b and M1c, respectively (P < 0.001). Systemic chemotherapy combined with radical loco-regional radiotherapy may benefit patients in M1a and M1b, not in M1c. Further aggressive treatment of metastatic lesions based on systemic chemotherapy and definitive loco-regional radiotherapy showed no survival benefit, even for patients in M1a (P > 0.05). CONCLUSION: The subdividing of M1 provided promising prognostic value and could aid clinicians in choosing the most suitable treatment for de novo mNPC patients.

The complete mitochondrial genome of the common buckeye Junonia coenia (Insecta: Lepidoptera: Nymphalidae).

The complete mitochondrial genome of the common buckeye Junonia coenia (Insecta: Lepidoptera: Nymphalidae) was reconstructed from whole-genome Illumina sequencing data with an average coverage of 1213×. The circular genome is 15 222 bp in length, and consists of 22 transfer RNAs (tRNAs), 13 protein-coding genes (PCGs), two ribosomal RNAs (rRNAs) and one D-loop region. All PCGs are initiated with ATN codons. Five PCGs (COX1, COX2, CYTB, ND2 & ND4) harbor an incomplete termination codon T--, while all the others are terminated with TAA. The nucleotide composition is highly asymmetric (39.6% A, 11.6% C, 7.7% G & 41.1% T) with an overall GC content of 19.3%. Phylogenetic analysis suggested that J. coenia is phylogenetically closer to its congeners and its consubfamilial counterparts than to the other taxa.

[Derivative synchronous fluorimetry for determination of synthetic food dyes in food].

The first order derivative synchronous fluoremetry was proposed for simultaneous determination of sunset yellow and ponceau 4R The effect of different experimental conditions, such as different pH for character of fluorescence spectra and the choosing of the optimal wavelength difference were studied. It was showed that the zero-crossing points were at 313. 6 nm for ponceau 4R and at 302. 8 nm for sunset yellow in first order derivative synchronous fluorescence spectra. Therefore, 313. 6 and 302. 8 nm were selected for the determination of sunset yellow and ponceau 4R when delta lambda= 130 nm. This method could minimize interference without preseparation. The linear ranges of sunset yellow and ponceau 4R were from 0. 1 to 2. 0 mg L-1 and from 0. 1 to 4. 0 mg L-1 with correlation coefficient 0. 996 6 and 0. 999 2, the detection limits were 0. 041 and 0. 019 mg L-1 , RS-Ds were 4. 6% and 4. 8% (n=6), respectively. The recoveries varied from 91. 0% to 110%. The proposed method was successfully applied in simultaneous determination of sunset yellow and Ponceau 4R in food.

[Resection of parapharyngeal neoplasms via styloid diaphragm approach].

OBJECTIVE: To evaluate the surgical technique and efficacy of the resection of parapharyngeal space neoplasm via styloid diaphragm approach. METHODS: Thirty-three cases underwent the resection of parapharyngeal space tumors via styloid diaphragm approach from Jan 2005 to Jan 2011 were reviewed. Of the cases, 28 were with benign tumors treated by surgery alone, and 5 were malignant tumors treated by surgery plus postoperative radical radiotherapy. RESULTS: The parapharyngeal neoplasms in all cases were completely resected via styloid diaphragm approach. The postoperative follow-up ranged from 13 months to 7 years (median = 4.6 years). No tumor recurrence was found in 30 cases, but 3 cases experienced tumor recurrence, including 1 chondrosarcoma (3 years after surgery and chemoradiotherapy), 1 chordoma and 1 adenoid cystic carcinoma (5 years after surgery and radiotherapy). Severe postoperative complications were not observed, but 2 cases showed mild mouth askew and fully recovered after 3 months, and 1 case was complicated with hoarseness and cough symptoms that disappeared after heteropathy. CONCLUSION: Resection of parapharyngeal neoplasms via styloid diaphragm approach is an ideal surgical technique, with well-exposed surgical field, less tissue injury, and less postoperative complication.

Endoscopic surgery of cavernous sinus tumors originating from the extradura.

In the present study, we explored the effects of various endoscopic approaches in patients with cavernous sinus (CS) tumors. Five endoscopic approaches, including the endoscopic transseptal transsphenoidal approach, extended endoscopic transseptal transsphenoidal approach, extended transnasal transmaxillary approach, extranasal extended maxillary sinus approach, and endoscopic transnasal transpterygoid approach, were selected for the resection of CS tumors from 36 patients. Thirty gross total tumors and 6 subtotal tumors were removed. After a follow-up period of 6 months to 3 years, 30 patients were determined to be recurrence-free, and 2 patients had unchanged residual tumors. One patient with a recurrent pituitary adenoma underwent a second surgery, and 1 patient with chordoma died because of an intracavernous carotid artery rupture 18 months after the operation. Various endoscopic approaches tailored to the origin and extent of the CS tumor were proven efficacious for the maximal and precise removal of CS tumors while avoiding vital structures.

[Synthesis of maleic anhydride-acrylamide copolymer and study of its adsorption properties by ICP-AES].

A novel adsorbent was prepared with maleic anhydride and acrylamide as functional monomer, N, N-methylenebisacrylamide as cross-linking agent, and ammonium persulfate as initiator through aqueous polymerization reaction. The adsorbent was characterized by Fourier transmission infrared spectra (FTIR) and Thermogravimetry (TG). The adsorption properties and selectivity properties were investigated by inductively coupled plasma atomic emission spectrum (ICP-AES). The result indicated that the optimum acidity was pH 3.5 and the reaction attained equilibrium at 1 h under stirring. The polymer adsorbent exhibited high selectivity for Fe3+ and its saturated adsorption capacity was 78.81 mg x g(-1). The adsorption kinetics was well described by pseudo-second kinetic equation, and the adsorption of the copolymer for Fe3+ accorded with Freundlich isothermal model. The adsorption process was found to be endothermic.

Effect of orange peel essential oil on oxidative stress in AOM animals.

The processing parameters of pump speed, inlet air temperature, outlet air temperature and homogenization pressure were evaluated. Encapsulation efficiency is high with a satisfied releasing rate. Then, acute otitis media (AOM) animal model was built and diet containing orange peel essential oil microcapsules were administrated to AOM animals. Pharmacological test showed that orange peel essential oil treatment could decrease serum and cochlea malondialdehyde (MDA), immunoglobulins A (IgA), immunoglobulins G (IgG), immunoglobulins M (IgM) levels and increase antioxidant enzymes activities. It can be concluded that orange peel essential oil treatment could decrease oxidative injury in acute otitis media rats.

[Endoscopic posterior septectomy for patients with nasopharyngeal tumor].

OBJECTIVE: To explore the techniques, advantages and disadvantages, indications and cautions of a surgical approach for the resection of nasopharyngeal tumor. METHODS: Ten cases with nasopharyngeal tumors were recruited in this study, of them, 3 cases with residual nasopharyngeal carcinoma after chemoradiotherapy, 2 cases with cavernous angioma, 2 cases with benign mixed tumor, 1 malignant mixed tumor, 1 adenoid cystic carcinoma, and 1 chordoma. All patients underwent endoscopic resection of posteroinferior quarter part of nasal septum, and then the removal of nasopharyngeal tumors through bilateral transnasal approach. RESULTS: Total resection of the tumor was achieved for all cases without severe surgical complications. All cases with benign tumors, with following-up of 6-18 months, showed no recurrence. Of 6 cases with malignant tumors, with following-up of 12-48 months, 5 cases showed no recurrence, and 1 case was suspected to relapse one year postoperatively, but not with any lesion enlargement after another 6 month follow-up. CONCLUSIONS: Posteroinferior quarter part of nasal septectomy is preferred for endoscopic resection of nasopharyngeal tumors because it can provide a panoramic view on nasopharyngeal cavity and tumors, thus, facilitating the removal of nasopharyngeal tumors.

[Prevention and management of complications of endoscopic surgery for nasal-skull base neoplasms].

OBJECTIVE: To analyze the surgical complications of endoscopic nasal-skull base surgery. The secondary objective was to propose the preliminary strategies for prevention and treatment of complications. METHODS: One hundred and thirty two patients with nasal-skull base tumors undergoing endoscopic or endoscope-assisted surgery were included in this study. Surgical approaches included endoscopic endonasal transethmoidal approaches, endoscopic endonasal transseptal transsphenoidal approach, extended endoscopic endonasal transseptal transsphenoidal approach, endoscopic transmaxillary posttrial wall approach, extended endoscopic transmaxillary posttrial wall approach, endoscopic nasal lateral wall dissection, maxillary osteotomy approach and endoscopic transoropharyngeal approach. These approaches were selectively used to resect the tumors in the area of nasal-skull base. RESULTS: The total resection of the tumors was obtained in 104 patients (104/132, 78.8%), with 29.5% (39/132) incidence of complications, including profuse bleeding, nerve injury, cerebrospinal fluid leakage, diabetes insipidus, electrolyte imbalance, hyperglycemia, and psychological disturbance. No catastrophic complications, sequelae and operative mortality encountered. Four months to 8 years' follow up (median 3.0 years) indicated that recurrence rate of the benign tumor was 9% (9/100) without died case, and 3-year and 5-year survival rates of the malignant tumor were 75.0% and 55.6%, respectively. CONCLUSIONS: Strategies proved to be effective in reduction of the overall incidence of the complications, especially in minimizing the catastrophic complications and sequelae. The strategies were as follows: first, according to original site, extension and characteristics of the tumor, designing appropriate endoscopic approaches for the treatment of skull base tumor; second, recognizing reliable surgical access points and safe plane of the dissection; third, predicting surgical risks preoperatively and proposing the corresponding plan to avoid these risks; fourth, acquainted with the endoscopic skills and familiarized the skull base structures; lastly, ensuring the correct management of the interdisciplinary problems with close collaboration with the interdisciplinary medical personnels.

[A preliminary study of endoscopic transoral trans-posteriorwall pharynx resection of hypo-clivus chordoma].

OBJECTIVE: To introduce a endoscopic surgical approach for hypo-clivus chordoma, and to explore the clinical value of the endoscopic resection of hypo-clivus chordoma. METHODS: Three hypo-clivus chordoma were resected by endoscopic transoral tans-posteriorwall pharynx approach. RESULTS: The MR image showed that total removal of the tumor was achieved in 2 patients and subtotal resection was received in one patient. No severe postoperative complications and sequelae occurred. In 6 months to 2 years' follow-up, the MRI showed that 2 patients had no residue tumor, and one patient died due to recurrence of the tumor 1 year after operation. CONCLUSION: The endoscopic transoral tans-posteriorwall pharynx approach might be valuable in the treatment of the hypo-clivus chordoma. The use of the endoscope allows for direct access to the hypo-clivus lesions while minimizing the chances of surrounding anatomic structure injury. In addition, this approach has the advantages of quick recovery, avoidance of catastrophic complications and sequelae. Especially, various angle view of the endoscope provides a panoramic view of the hypo-clivus, thus exposing and resecting hide lesion which can not be exposed by other approaches. This approach might facilitate complete resection of the chordoma with maximal preservation of normal tissues.

[Surgical approaches for different stages of nasopharyngeal angiofibromas].

OBJECTIVE: To explore the optical surgical approaches for the resection of early and advanced stage of nasopharyngeal angiofibromas. METHODS: Twenty two male patients aged 9 - 30 years (median 16 years) hospitalized in Xiangya Hospital from June 2003 to July 2006 with nasopharyngeal angiofibroma were recruited. Five operative approaches were selected according classification of juvenile nasopharyngeal angiofibroma described by Fisch. Six cases with stage I nasopharyngeal angiofibroma underwent endoscopic transnasal surgery. Six cases with stage II and 2 cases with stage III underwent endoscopic endonasal middle meatal transmaxillary-antrum approach. Three cases with stage III and 2 cases with stage IV underwent endoscopic endonasal middle and inferior meatal approach with extended transmaxillary-antrum resection. One case with stage IV underwent microscopic preauricula infratemporal fossa approaches combined with endoscopic endonasal middle and inferior meatal transantral approach. Two cases with stage IV underwent nasomaxillary osteotomy approach. RESULTS: After surgery, CT scan or MR image showed that total removal of the tumor was achieved in 21 patients. One patient who received subtotal resection were performed by second endoscopic surgery and obtained total resection. No postoperative complications have been encountered in all treated patients. Nine months to 3 years follow up indicated that no cases recurred after surgery. CONCLUSIONS: Appropriate surgical approach should be selected according to the clinical classification and whether the tumor has extended into whole nasal cavity, lateral fossa infratemporalis, intracranial or not. Such approaches might better facilitate the complete removal of nasopharyngeal angiofibromas and reduce the surgery-related injury.

Resection of extensive sellar tumors with extended endoscopic transseptal transsphenoidal approach.

The endoscope has recently been used to extensive sellar lesions, but the extended areas of the lesions and operative techniques vary from each study. Here we present our experience with extended endoscopic transseptal transsphenoidal (EETT) approach to 16 patients with extensive sellar lesion and evaluate the feasibility of EETT in different extensive sellar tumor resection. Sixteen patients with extensive sellar lesion were operated by EETT approach in this study. The approach included unilateral posterior septum mucosa resection, posterior septectomy, extended ethmoidectomy and sphenoidoctomy, four tumoral circumferences (bilateral, superior, inferior aspects) isolated and subsequently tumoral removal from outside to inside of the tumors obtained. This surgical procedure is satisfactory for sellar lesion with different juxtasellar extension. After surgery, CT scan and MR image showed that total removal of the tumor was achieved in 10 patients. Six patients who received subtotal resection were treated with postoperative radiation therapy or gamma knife surgery. Two patients developed postoperative cerebrospinal fluid leak that was successfully managed by conservative treatment within 6 days after surgery. No other new postoperative endocrinological or neurological defects occurred. Six months to 5 years follow up indicated that all 16 patients with the visual disturbances and 4 patients with endocrine impairments have recovered or improved. One patient with malignant meningioma died due to recurrence of the tumor 2 years postoperation. Another one patient with malignant inverted papilloma recurred 1 year postoperation and underwent operation and radiation therapy again. The EETT approach might better facilitate the removal of different extensive sellar lesions with maximal preservation of important anatomical structures and nasal function.