2,5-Dihydroxyacetophenone attenuates acute kidney injury induced by intra-abdominal infection in rats.

AIMS: As one of the most serious complications of sepsis, acute kidney injury (AKI) is pathologically associated with excessive inflammation. 2,5-Dihydroxyacetophenone (DHAP) is isolated from Radix rehmanniae praeparata and exhibit potent anti-inflammatory property. This research aimed at determining the role of DHAP in sepsis-associated AKI (SA-AKI) and the underlying mechanism. METHODS: Plasma creatinine (Cre), blood urea nitrogen (BUN), tumour necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß) levels of SA-AKI patients were detected to evaluate their clinical characteristics. SA-AKI rat models were established by using caecum ligation puncture (CLP) surgery. CLP-induced rats were administered via oral gavage with 20 or 40 mg DHAP after 2 h of CLP surgery. Subsequently, survival rates, serum indexes, histopathological changes, inflammatory factors, renal function indexes and extracellular regulated protein kinases (ERK) and nuclear factor-κB (NF-κB) signalling pathways were detected. RESULTS: SA-AKI patients exhibited markedly higher levels of plasma Cre, BUN, TNF-α and IL-1ß than healthy people. Compared with sham rats, CLP-induced septic rats showed significantly decreased survival rate, increased serum lactate dehydrogenase activity and serum lactate level, obvious renal histopathological injury, upregulated TNF-α, IL-1ß and TGF-ß1 levels, elevated serum creatinine, BUN and serum cystatin C concentrations, serum neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 levels and reduced renal artery blood flow. All the above CLP-induced changes in septic rats were mitigated after DHAP administration. Additionally, CLP-induced elevation in phosphorylated-ERK1/2 and nuclear NF-κB p65 protein levels was inhibited by DHAP treatment. CONCLUSION: DHAP hinders SA-AKI progression in rat models by inhibiting ERK and NF-κB signalling pathways.

MenSCs Transplantation Improve the Viability of Injured Endometrial Cells Through Activating PI3K/Akt Pathway.

Endometrial injury is one of the leading causes of female infertility and is caused by intrauterine surgery, endometrial infection, repeated abortion, or genital tuberculosis. Currently, there is little effective treatment to restore the fertility of patients with severe intrauterine adhesions and thin endometrium. Recent studies have confirmed the promising therapeutic effects of mesenchymal stem cell transplantation on various diseases with definite tissue injury. The aim of this study is to investigate the improvements of menstrual blood-derived endometrial stem cells (MenSCs) transplantation on functional restoration in the endometrium of mouse model. Therefore, ethanol-induced endometrial injury mouse models were randomly divided into two groups: the PBS-treated group, and the MenSCs-treated group. As expected, the endometrial thickness and gland number in the endometrium of MenSCs-treated mice were significantly improved compared to those of PBS-treated mice (P < 0.05), and fibrosis levels were significantly reduced (P < 0.05). Subsequent results revealed that MenSCs treatment significantly promoted angiogenesis in the injured endometrium. Simultaneously, MenSCs enhance the proliferation and antiapoptotic capacity of endometrial cells, which is likely contributed by activating the PI3K/Akt signaling pathway. Further tests also confirmed the chemotaxis of GFP-labeled MenSCs towards the injured uterus. Consequently, MenSCs treatment significantly improved the pregnant mice and the number of embryos in pregnant mice. This study confirmed the superior improvements of MenSCs transplantation on the injured endometrium and uncovered the potential therapeutic mechanism, which provides a promising alternative for patients with serious endometrial injury.

Nitrogen removal performance and rapid start-up of anammox process in an electrolytic sequencing batch reactor (ESBR).

In this study, the electrolytic sequencing batch reactor (ESBR) with different current densities was constructed to investigate the nitrogen removal performance and rapid start-up of anaerobic ammonia oxidation (anammox) process. The changes of total nitrogen removal rate (TNRR), specific anammox activity (SAA) and nitrogen concentration under different current densities were analyzed, and then the effect of the optimal current density on the start-up of anammox in ESBR was explored. The results showed that ammonium nitrogen removal efficiency (92.7%), nitrite nitrogen removal efficiency (15.5%) and total nitrogen removal efficiency (28.1%) were obtained with the TNRR and SAA were 0.0118 g N L-1 d-1 and 0.0050 g N (g Vss d)-1, respectively under the optimal conditions (i.e., current density = 0.10 mA cm-2, temperature = 36 °C and pH = 7.6). In addition, the stoichiometric ratio indicated that anammox was initiated successfully for 91 days in ESBR with the current density of 0.10 mA cm-2, which was shortened by 10 days compared with the conventional SBR without current density. These results suggest that an array of rapid start-up processes of anammox can be developed through applying current density to stimulate the activity of anammox bacteria (AnAOB).

tiRNA-Val promotes angiogenesis via Sirt1-Hif-1α axis in mice with diabetic retinopathy.

BACKGROUND: Diabetic retinopathy (DR) is a specific microvascular complication arising from diabetes, and its pathogenesis is not completely understood. tRNA-derived stress-induced RNAs (tiRNAs), a new type of small noncoding RNA generated by specific cleavage of tRNAs, has become a promising target for several diseases. However, the regulatory function of tiRNAs in DR and its detailed mechanism remain unknown. RESULTS: Here, we analyzed the tiRNA profiles of normal and DR retinal tissues. The expression level of tiRNA-Val was significantly upregulated in DR retinal tissues. Consistently, tiRNA-Val was upregulated in human retinal microvascular endothelial cells (HRMECs) under high glucose conditions. The overexpression of tiRNA-Val enhanced cell proliferation and inhibited cell apoptosis in HRMECs, but the knockdown of tiRNA-Val decreased cell proliferation and promoted cell apoptosis. Mechanistically, tiRNA-Val, derived from mature tRNA-Val with Ang cleavage, decreased Sirt1 expression level by interacting with sirt1 3'UTR, leading to the accumulation of Hif-1α, a key target for DR. In addition, subretinal injection of adeno-associated virus to knock down tiRNA-Val in DR mice ameliorated the symptoms of DR. CONCLUSION: tiRNA-Val enhance cell proliferation and inhibited cell apoptosis via Sirt1/Hif-1α pathway in HRMECs of DR retinal tissues.

tiRNA-Val promotes angiogenesis via Sirt1-Hif-1α axis in mice with diabetic retinopathy

BACKGROUND: Diabetic retinopathy (DR) is a specific microvascular complication arising from diabetes, and its pathogenesis is not completely understood. tRNA-derived stress-induced RNAs (tiRNAs), a new type of small noncoding RNA generated by specific cleavage of tRNAs, has become a promising target for several diseases. However, the regulatory function of tiRNAs in DR and its detailed mechanism remain unknown. RESULTS: Here, we analyzed the tiRNA profiles of normal and DR retinal tissues. The expression level of tiRNA-Val was significantly upregulated in DR retinal tissues. Consistently, tiRNA-Val was upregulated in human retinal microvascular endothelial cells (HRMECs) under high glucose conditions. The overexpression of tiRNA-Val enhanced cell proliferation and inhibited cell apoptosis in HRMECs, but the knockdown of tiRNA-Val decreased cell proliferation and promoted cell apoptosis. Mechanistically, tiRNA-Val, derived from mature tRNA-Val with Ang cleavage, decreased Sirt1 expression level by interacting with sirt1 3'UTR, leading to the accumulation of Hif-1α, a key target for DR. In addition, subretinal injection of adeno-associated virus to knock down tiRNA-Val in DR mice ameliorated the symptoms of DR. CONCLUSION: tiRNA-Val enhance cell proliferation and inhibited cell apoptosis via Sirt1/Hif-1α pathway in HRMECs of DR retinal tissues.

Functional Olfactory Nerve Regeneration Demonstrated by Thallium-201 Olfacto-Scintigraphy in Patients with Traumatic Anosmia: A Case Report.

Head trauma is one of the most common etiologies of olfactory dysfunction. It is difficult to use either the olfactory function test or magnetic resonance imaging to directly assess the course of damage to olfactory nerves. Thallium-201 (201Tl) olfacto-scintigraphy has been shown to be an able means for objectively assessing the olfactory nerve transport function. It is expected to be used to evaluate olfactory nerve regeneration after damage to the olfactory nerves. However, no such result has been reported. We present a patient who lost his olfactory function after experiencing head trauma. When his olfactory function remained anosmic, a 201Tl olfacto-scintigraphy showed no migration of 201Tl from the nasal mucosa to the olfactory bulb. After treatment with medicines and olfactory training, his olfactory function improved. A second 201Tl olfacto-scintigraphy showed an increased migration of 201Tl from the nasal mucosa to the olfactory bulb.

Clitoral Metastasis From Advanced Cervical Carcinoma on 18F-FDG-PET/CT.

Metastatic tumors of the clitoris from cervical carcinoma are extremely rare. Here, we described a 54-year-old woman with clitoral metastasis from cervical carcinoma demonstrated on F-FDG PET/CT images.

To evaluate the treatment response of locally advanced esophageal cancer after preoperative chemoradiotherapy by FDG-PET/CT scan.

BACKGROUND: This study was designed to gauge the effectiveness of evaluation of tumor response and prognosis by positron emission tomography with 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) before and after preoperative chemoradiotherapy in patients with esophageal cancer. METHODS: Forty-nine patients from October 2008 to September 2012 with locally advanced stage esophageal carcinoma, clinical stage T2-4N0-3M0, who underwent preoperative chemoradiotherapy (pre-CRT) followed by esophagectomy were enrolled in our study. All patients underwent two FDG-PET scans to compare those results with the pathologic results. Metabolic response of the primary tumor by the percentage change of the SUVmax/1 hour (ΔSUV) before and after pre-CRT (ΔSUV was calculated as the difference between pre-CRT SUVmax/1 hour and post-CRT SUVmax/1 hour divided by pre-CRT SUVmax/1 hour at esophageal tumor) was evaluated for overall survival (OS), disease free survival (DFS), local recurrence rate, and distant failure free survival (DFFS). Prognostic factors such as age, different regimen of chemotherapy, pathologic stage, FDG-PET stage, endoscopic esophageal tumor length, and ΔSUV were analyzed. The number of highly suspect malignant lymph nodes was calculated by PET when SUVmax/1 hour ≥2.5 and by surgical removal. Sensitivity and specificity of regional lymph node detection by PET were also recorded. RESULTS: Upon univariate analysis, overall survival rate was related to ΔSUV >60% (p = 0.045), pathological N stage (p = 0.001), and endoscopic total length of esophageal tumor (p = 0.005). The result of FDG-PET scan after pre-CRT had high specificity (96.7%) but low sensitivity (45.8%) in predicting the residual malignant lymph node numbers. The positive and the negative prediction rates were 44% and 96%, respectively. The result of the FDG-PET after pre-CRT showed upstaged in 16 patients (32.6%), downstaged in nine patients (18.3%), and the same stage in 24 patients (48.9%) when compared with the pathologic stage [corrected]. CONCLUSION: The change of SUVmax can be a tool for evaluating tumor response after pre-CRT. There is also a trend of good prognosis in overall survival rate when ΔSUV value is >60%.

Nasal cavity metastasis of breast cancer: a case report and review of the literature.

OBJECTIVE: The nasal cavity is an uncommon site for metastasis to develop and thus metastases arising from breast cancer are rarely observed. We report a case of a 61-year-old female with two-year history of breast cancer who presented with a nasal cavity that was diagnosed as metastatic breast carcinoma by histopathological analysis of the nasal cavity specimen. METHODS: We reviewed the clinical records of the patient and the appropriate world literature. RESULTS: The patient had been diagnosed with breast cancer two years before. Her present complain was oculus dexter visual acuity decreased. CT and MRI scan revealed a palpable mass on the right nasal cavity. PET/CT demonstrated no additional uptake at the level of other organ. ER and PR demonstrated a similar expression pattern in primary breast carcinoma and nasal cavity lesions. As further treatment she received systemic palliative chemotherapy in addition to intravenous treatment with bisphosphonates, and a total dose of 36 Gy of X-ray (3 Gy per day, 12 fractions) was given to the local site of the right nasal cavity. CONCLUSION: In patient with a previous history of breast cancer who complains even of ophthalmologic symptoms such as visual acuity decreased, it is important to consider nasal cavity metastatic disease. 18FDG-PET/CT is useful to rule out the presence of other organ metastasis. Histopathological analysis may aid the diagnosis. The establishment of treatment strategies based on a comprehensive understanding of both etiology and pathophysiology is needed for rare cases such as this.

18F-FDG PET or PET/CT for detecting extensive disease in small-cell lung cancer: a systematic review and meta-analysis.

The purpose of this study was to conduct a systematic review and meta-analysis of the published literature to evaluate the diagnostic accuracy of fluorine-18 2-fluoro-2-deoxy-D-glucose (F-FDG) PET or PET/computed tomography (CT) in the pretherapeutic staging of patients with small-cell lung cancer (SCLC). The authors conducted a systematic MEDLINE search of published articles. Two reviewers independently assessed the methodological quality of each study. We estimated the pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), and summary receiver operating characteristic curves in the detection of extensive disease (ED) in patients with SCLC. Twelve studies with a total of 369 patients met the inclusion criteria. The pooled estimates of sensitivity, specificity, LR+, and LR- of F-FDG PET or PET/CT for the detection of ED in SCLC were 97.5% [95% confidence interval (CI), 94.2-99.2%], 98.2% (95% CI, 94.9-99.6%), 19.86 (95% CI, 9.79-40.30), and 0.06 (95% CI, 0.03-0.10), respectively. Whole-body F-FDG PET or PET/CT is a valuable imaging tool for the pretherapeutic assessment of ED in patients with SCLC.

Laryngo-tracheobronchial amyloidosis: a case report and review of literature.

AMYLOIDOSIS is a benign process which can have systemic involvement. Though larynx is the common site of localized amyloidosis in the head and neck region,1 it was seldom reported with heterochronous implication of bilateral ventricles. Here we report a case of laryngeal amyloidosis heterochronously localized at bilateral ventricles with tracheobronchial involvement. Combined with our experience we reviewed the literature, and discuss the pertinent managements of this condition.

A mass resulting from cerebral spinal fluid collection of ventriculopleural shunt: radiographic and radionuclide findings.

A 49-year-old man was brought to our hospital because of lethargy. His medical history was hydrocephalus with ventriculoperitoneal shunt initially. The ventriculoperitoneal shunt was replaced several times owing to malfunction, and it was later replaced with a right-sided ventriculopleural shunt. The chest radiograph revealed a mass at the right lung. The mass was a capsular collection of cerebral spinal fluid (CSF) in the right pleural cavity diagnosed based on radionuclide shuntogram findings.

Use of FDG-PET or PET/CT to detect recurrent colorectal cancer in patients with elevated CEA: a systematic review and meta-analysis.

AIM: The purpose of the present study was to conduct a systematic review and meta-analysis of the published literature to assess the diagnostic performance of FDG-PET or PET/CT in the detection of recurrent colorectal cancer (CRC) rising in patients with elevated CEA. MATERIALS AND METHODS: The authors conducted a systematic MEDLINE search of published articles. Two reviewers independently assessed the methodological quality of each study. We estimated pooled sensitivity and specificity and positive and negative likelihood ratios, and summary receiver-operating characteristic curves in the detection of recurrent CRC in patients with elevated CEA. RESULTS: Eleven studies with a total of 510 patients met the inclusion criteria. One hundred and six patients (106/510 = 20.8%) had true-negative FDG-PET (PET/CT) results in detection of recurrent CRC when rising CEA. The pooled estimates of sensitivity and specificity and positive and negative likelihood ratios of FDG-PET in the detection of tumor recurrence in CRC patients with elevated CEA were 90.3% (95% CI, 85.5-94.0%), 80.0% (95% CI, 67.0-89.6%), 2.88 (95% CI, 1.37-6.07), and 0.12 (95% CI, 0.07-0.20), respectively. The pooled estimates of sensitivity and specificity and positive and negative likelihood ratios of FDG-PET/CT in the detection of tumor recurrence in CRC patients with elevated CEA were 94.1% (95% CI, 89.4-97.1%), 77.2% (95% CI, 66.4-85.9%), 4.70 (95% CI, 0.82-12.13), and 0.06 (95% CI, 0.03-0.13), respectively. CONCLUSIONS: Whole-body FDG-PET and PET/CT are valuable imaging tools for the assessment of patients with suspected CRC tumor recurrence based on the increase of CEA.

FDG PET/CT for the preoperative nodal staging of non-small cell lung cancer in a tuberculosis-endemic country: Are maximum standardized uptake values useful?

BACKGROUND: The aim of this study was to determine an optimum standardized uptake value threshold for identifying nodal metastasis in non-small cell lung cancer (NSCLC) patients using Fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) in Taiwan, a tuberculosis-endemic country. The variation in standardized uptake values of nodal metastasis among different NSCLC histological subtypes was also evaluated. METHODS: We retrospectively reviewed 75 NSCLC patients who had received FDG PET/CT before surgery. The diagnostic accuracy of FDG PET/CT for the preoperative nodal staging was evaluated by histopathologic findings. RESULTS: A total of 316 nodal stations were evaluated. The sensitivity and specificity of FDG PET/CT for nodal staging were 58.6% and 81.8%, respectively, using an SUV cut-off of 2.6. With regard to the levels of mean SUVmax in true-positive and false-positive groups, there was no significant difference among different histological subtypes. CONCLUSION: The present study demonstrated that FDG PET/CT for pre-operative nodal staging using SUVmax > 2.6 is a useful tool (with a higher specificity and a higher negative predictive value) to rule out the possibility of metastatic lymphadenopathy in operable patients with NSCLC.

Meta-analysis of the diagnostic performance of [18F]FDG-PET and PET/CT in renal cell carcinoma.

OBJECTIVES: Positron emission tomography (PET) using fluorodeoxyglucose (FDG) is useful for restaging renal cell carcinoma (RCC) and detecting metastatic diseases but is less satisfactory for detecting primary disease. We evaluated whether the integration of computed tomography (CT) scans with the PET system could increase the applicability of FDG-PET for RCC. METHODS: The MEDLINE databases were searched for relevant studies published since 2001. Two reviewers independently assessed the methodological quality of each study identified. We then performed a meta-analysis of the sensitivity and specificity of FDG-PET findings as reported in all the selected studies. RESULTS: Fourteen studies were eligible for inclusion. The pooled sensitivity and specificity of FDG-PET were 62% and 88% respectively, for renal lesions. For detecting extra-renal lesions, the pooled sensitivity and specificity of FDG-PET were 79% and 90%, respectively, based on the scans, and 84% and 91% based on the lesions. The use of a hybrid FDG-PET/CT to detect extra-renal lesions increased the pooled sensitivity and specificity to 91% and 88%, respectively, with good consistency. CONCLUSIONS: For RCC, combining the FDG-PET and CT systems is helpful for detecting extra-renal metastasis rather than renal lesions. The hybrid PET/CT system has comparable sensitivity and specificity with PET in detecting extra-renal lesions of RCC. ADVANCES IN KNOWLEDGE: The FDG-PET and PET/CT systems are both useful for detecting extra-renal metastasis in renal cell carcinoma.

A systematic review and meta-analysis of pretherapeutic lymph node staging of colorectal cancer by 18F-FDG PET or PET/CT.

The purpose of the present study was to conduct a systematic review and meta-analysis of the published literature to evaluate the diagnostic performance of fluorine-18 2-fluoro-2-deoxy-D-glucose (18F-FDG) PET in the pretherapeutic assessment of nodal staging in patients with colorectal cancer (CRC). We conducted a systematic MEDLINE search of articles in the published literature (last update, February 2012). Two reviewers independently assessed the methodological quality of each study. We estimated pooled sensitivity, specificity, summary receiver operating characteristic curves, and summary likelihood ratios. A total of 409 patients from 10 studies were analyzed. The pooled estimates of sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 18F-FDG PET [PET/computed tomography (CT)] in the detection of pretherapeutic lymph node involvement in patients with CRC were 42.9% [95% confidence interval (CI): 36.0-50.0%], 87.9% (95% CI: 82.6-92.0%), 2.82 (95% CI: 1.96-4.07), and 0.69 (95% CI: 0.62-0.78), respectively. There is no solid evidence to support the routine clinical application of 18F-FDG PET (PET/CT) in the pretherapeutic evaluation of lymph node status in patients with CRC. However, 18F-FDG PET (PET/CT) could be used to strengthen the possibility of suspected metastatic lymph nodes detected by other imaging modalities.

FDG PET or PET/CT for detecting intramedullary and extramedullary lesions in multiple Myeloma: a systematic review and meta-analysis.

AIM: The purpose of the current study was to conduct a systematic review and meta-analysis of the published literature to evaluate the diagnostic accuracy of FDG PET or PET/CT for intramedullary and extramedullary lesions in multiple myeloma. METHODS: The authors conducted a systematic MEDLINE search of published articles. Two reviewers independently assessed the methodological quality of each study. We estimated pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), and summary receiver operating characteristic curves in the detection of intramedullary and extramedullary lesions in multiple myeloma. RESULTS: Fourteen studies with a total of 395 patients met the inclusion criteria. The pooled estimates of sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of FDG PET or PET/CT for the detection of extramedullary lesions in multiple myeloma were 96.0% [95% confidence interval (CI), 79.6%-99.9%], 77.8% (95% CI, 40.0%-97.2%), 3.28 (95% CI, 1.29-8.32), and 0.12 (95% CI, 0.03-0.42), respectively. The pooled estimates of sensitivity, specificity, LR+, and LR- of FDG PET or PET/CT for the detection of intramedullary lesions in multiple myeloma were 61.1% (95% CI, 43.5%-76.9%), 94.1% (95% CI, 71.3%-99.9%), 5.73 (95% CI, 1.53-21.40), and 0.43 (95% CI, 0.28-0.65), respectively. CONCLUSIONS: Whole-body FDG PET or PET/CT is a valuable imaging tool for the assessment of patients with multiple myeloma, especially for the appraisal of extramedullary involvement.

Regional cerebral blood flow in patients with carbon monoxide intoxication.

RATIONALE AND OBJECTIVES: Early detection of regional cerebral anomalies in acute carbon monoxide (CO) poisoning by (99m)Tc-hexamethylprophylene amine oxime (HMPAO) brain single photon emission computed tomography (SPECT) imaging has been reported previously. However, SPECT findings varied in these studies because of their small population sizes. In this study, we included 96 patients with acute CO intoxication and analyzed the regional perfusion changes in these patients by means of HMPAO brain SPECT. MATERIALS AND METHODS: Ninety-six patients, aged 4-80 years (mean age 32 years) with acute CO intoxication diagnosed by our emergency department were included in this study. Exclusion criteria included previous cerebrovascular diseases, brain injury, brain surgery and any known neurological and psychological disorders. All patients underwent a brain scan using a dual-head camera and fan-beam collimator 90-120 min after injection of (99m)Tc-HMPAO. Brain SPECT images were obtained for interpretation. RESULTS: Our data suggested that 79 of the 96 patients (82.3 %) had abnormal HMPAO brain images. The predominant site of disease was basal ganglia (52/96 = 54.2 %), followed by temporal lobe (48/96 = 50.0 %), parietal lobe (44/96 = 45.8 %), frontal lobe (30/96 = 31.2 %), occipital lobe (21/96 = 21.9 %) and thalamus (8/96 = 8.3 %). No patients with acute CO intoxication had perfusion abnormalities in the cerebellum. In addition, there was no significant difference in serum COHb levels between patients with abnormal and normal HMPAO brain images. CONCLUSION: (99m)Tc-HMPAO SPECT imaging is a useful tool to detect functional brain injury in acute CO intoxication.

Bacterial biofilms in chronic rhinosinusitis and their relationship with inflammation severity.

AIMS: To identify the presence of bacterial biofilms on mucosal specimens from chronic rhinosinusitis (CRS) patients, and evaluate their relationship with severity of CRS. METHODS: A prospective study of biofilms presence on 24 CRS patients compared with 12 controls was designed. The presence of biofilms was determined by scanning electron microscopy (SEM), and associations with the preoperative Lund-MacKay CT scores, Johansson endoscopic scores, and the history of ESS were assessed. RESULTS: Biofilms were found in 13/24 CRS patients (54.2%) but in only 1/12 controls (8.3%; P<0.01). CRS patients with and without biofilms had similar preoperative Lund-MacKay CT and Johansson endoscopic scores (P>0.05). Patients with revision ESS showed a tendency of higher biofilms incidence (5/7, 71.4%) than those undergoing their first procedure (8/17, 47.1%), but did not reach a significant difference (P>0.05). CONCLUSIONS: The higher incidence of biofilms in CRS patients suggests a role in the pathogenesis of CRS, but no correlation with severity of CRS.