Diagnostic criteria for eosinophilic chronic rhinosinusitis: Comparative analysis and novel scoring system.

BACKGROUND: Accurate identification of eosinophilic chronic rhinosinusitis is essentialg because its treatment and prognosis substantially differ from other subtypes. METHODS: This retrospective observational study included 640 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis in a single tertiary center from January 2021 to December 2022. Receiver operating characteristic curves were generated to compare accuracy, sensitivity, specificity of the novel scoring system, and previous diagnostic criteria (Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis, European Forum for Research and Education in Allergy and Airway Diseases, European Position Paper on Rhinosinusitis and Nasal Polyps, and Sakuma et al.) for predicting eosinophilic chronic rhinosinusitis (ECRS) by tissue eosinophil count ≥70 per high power field. RESULTS: Patients were randomly divided into estimation (n = 430) and validation (n = 210) groups. The area under the receiver operating characteristic curve for the novel score was 0.753 (95% confidence interval [CI], 0.670-0.835) in the estimation group, 0.729 (0.629-0.830) in the validation group, and 0.661 (0.584-0.738) in the 20-fold cross-validation with the entire dataset. CONCLUSIONS: We propose a novel scoring system that incorporates three key parameters: "novel score = blood eosinophil (%) + total Lund-Mackay score of anterior ethmoid sinuses + 2 if nasal polyp present" greater than 7 can be reliably used for diagnosing ECRS. This system can facilitate decision-making processes regarding the administration of oral steroids and biologics targeting type 2 inflammation prior to surgical intervention.

Tissue specific stem cell therapy for airway regeneration.

Secondary atrophic rhinitis (AR), a consequence of mucosal damage during nasal surgeries, significantly impairs patient quality of life. The lack of effective, lasting treatments underscores the need for alternative therapeutic strategies. A major impediment in advancing research is the scarcity of studies focused on secondary AR. Our study addresses this gap by developing an animal model that closely mirrors the histopathological changes observed in patients with secondary AR. These changes include squamous metaplasia, goblet cell hyperplasia, submucosal fibrosis, and glandular atrophy. Upon administering human nasal turbinate stem cells embedded in collagen type I hydrogel in these models, we observed ciliary regeneration. This finding suggests the potential therapeutic benefit of this approach. Our animal models not only emulate the clinical manifestations of secondary AR but also serve as valuable tools for evaluating the efficacy of cell-based biotechnological interventions.

Development of ratiometric fluorescent probes based on peptides for sensing Pb2+ in aquatic environments and human serum.

The detection of Pb2+ ions in aquatic environments and biofluid samples is crucial for assessment of human health. Herein, we synthesized two fluorescent probes (1 and 2) consisting of the peptide receptor for Pb2+ and a benzothiazolyl-cyanovinylene fluorophore that exhibited excimer-like emission when it aggregated. The peptide-based probes sensitively detected Pb2+ in purely aqueous solution (1% DMF) through ratiometric fluorescent response with a decrease in monomer emission at 520 nm and an increase in excimer emission at 570 nm. Specially, probe 2 showed remarkable detection features such as high selectivity for Pb2+over 15 metal ions, high binding affinity (Kd = 5.83 × 10-7 M) for Pb2+, significant emission intensity changes, low detection limit (3.8 nM) of Pb2+, high water solubility, and visible light excitation (450 nm). Probe 2 was successfully used to quantify nanomolar concentration (0 âˆ¼ 800 nM) of Pb2+ in real water samples (ground water and tap water). Specially, 2 was successfully applied for the quantification of Pb2+ in human serum by combination of microwave-assisted human serum digestion and filtration of digested serum by anion exchange cartridge. We clearly investigated the binding mode of 2 with Pb2+ using 1H NMR, IR spectroscopy, pH titration, confocal microscopy, and size analysis. The peptide-based fluorescent probe might have great application potential for sensing Pb2+ in aquatic environments and biofluid samples.

Stylet angulation of 70 degrees reduces the time to intubation with the GlideScope®: A prospective randomised trial.

Objective The GlideScope® videolaryngoscope provides a good view of the glottis. However, directing and inserting an endotracheal tube is sometimes difficult during intubation with the GlideScope®. In this study, we compared two GlideScope® stylet angulations (90° vs. 70°) in terms of the time to intubation. Methods In total, 162 patients scheduled for elective surgery under general anaesthesia were randomly assigned to one of two groups. In the 90 group ( n = 79), a 90° stylet was used. In the 70 group ( n = 78), a 70° stylet was used. The time to intubation was recorded. The number of intubation attempts was assessed. Results The time to intubation was significantly shorter in the 70 than 90 group [26.0 (23.0-32.0) vs. 37.0 (30.0-43.0) s, respectively]. The first-time intubation success rate was significantly higher and the number of failed intubations was significantly lower in the 70 than 90 group (100% vs. 87% and 0% vs. 6%, respectively). Conclusions This investigation suggests that a 70° angle stylet is superior to a 90° angle stylet for GlideScope® intubation. Trial Registration Clinicaltrials.gov Identifier: NCT02547064.

Insulin enhances RANKL-induced osteoclastogenesis via ERK1/2 activation and induction of NFATc1 and Atp6v0d2.

Insulin is one of the main factors affecting bone and energy metabolism, however, the direct effect of insulin on osteoclast differentiation remains unclear. Thus, in order to help elucidate that puzzle, the authors investigated the roles and regulatory mechanisms of insulin on osteoclasts differentiation. Co-stimulation with insulin and RANKL significantly enhanced the number of larger (>100 µm) osteoclastic cells and of TRAP-positive multinucleated cells compared with treatment by RANKL alone. Conversely, the insulin receptor shRNA markedly decreased osteoclast differentiation induced by insulin and RANKL. Insulin treatment significantly activated ERK1/2 MAP kinase as well as markedly induced the expression of NFATc1, an osteoclast marker gene, and Atp6v0d2, an osteoclast fusion-related gene. The pretreatment of PD98059, an ERK1/2 inhibitor, or insulin receptor shRNA effectively suppressed osteoclast differentiation and, in addition, blocked the expression of NFATc1 and Atp6vod2 induced by insulin stimulation. These data reveal insights into the regulation of osteoclast differentiation and fusion through ERK1/2 activation and the induction of NFATc1 and Atp6v0d2 by insulin.

Obatoclax regulates the proliferation and fusion of osteoclast precursors through the inhibition of ERK activation by RANKL.

Obatoclax, a pan-Bcl2 inhibitor, shows antitumor activities in various solid malignancies. Bcl2-deficient mice have shown the importance of Bcl2 in osteoclasts, as the bone mass of the mice was increased by the induced apoptosis of osteoclasts. Despite the importance of Bcl2, the effects of obatoclax on the proliferation and differentiation of osteoclast precursors have not been studied extensively. Here, we describe the anti-proliferative effects of obatoclax on osteoclast precursors and its negative role on fusion of the cells. Stimulation with low doses of obatoclax significantly suppressed the proliferation of osteoclast precursors in a dose-dependent manner while the apoptosis was markedly increased. Its stimulation was sufficient to block the activation of ERK MAP kinase by RANKL. The same was true when PD98059, an ERK inhibitor, was administered to osteoclast precursors. The activation of JNK1/2 and p38 MAP kinase, necessary for osteoclast differentiation, by RANKL was not affected by obatoclax. Interestingly, whereas the number of TRAP-positive mononuclear cells was increased by both obatoclax and PD98059, fused, multinucleated cells larger than 100 µm in diameter containing more than 20 nuclei were completely reduced. Consistently, obatoclax failed to regulate the expression of osteoclast marker genes, including c-Fos, TRAP, RANK and CtsK. Instead, the expression of DC-STAMP and Atp6v0d2, genes that regulate osteoclast fusion, by RANKL was significantly abrogated by both obatoclax and PD98059. Taken together, these results suggest that obatoclax down-regulates the proliferation and fusion of osteoclast precursors through the inhibition of the ERK1/2 MAP kinase pathway.

Up-regulation of cyclinD1 and Bcl2A1 by insulin is involved in osteoclast proliferation.

AIMS: Insulin receptor signaling in osteoblasts has been well established, but the effects of insulin on osteoclast proliferation are poorly explored. The objective of this study was to investigate the roles and the mechanisms of insulin on osteoclast proliferation. MAIN METHODS: After insulin treatment to primary osteoclast precursors, BrdU incorporation assay was performed and the expression of cell cycle- and apoptosis-related genes was determined by real-time PCR and immunoblotting. Apoptosis was analyzed using a FACScan flow cytometer. KEY FINDINGS: Insulin activated insulin receptor and promoted the proliferation of osteoclast precursors in time- and dose-dependent manners. However, the expression of insulin receptor was not changed by it during that time. Insulin remarkably induced the expression of cyclinD1, a cell cycle marker, and Bcl2A1, an anti-apoptotic oncogene, whereas cdk1 and cdk4 were not affected by it. The expression of Bcl2l11 and Bax, both apoptotic markers, was reduced or not changed in osteoclast precursors. Bcl2A1/Bax ratio was also increased in protein levels. Treatment with obatoclax, a Bcl2 family inhibitor, significantly induced the apoptosis of osteoclast precursors in the presence of insulin. These results demonstrate that insulin promotes osteoclast proliferation by increasing cell cycle and suppressing apoptosis through specific gene regulation. SIGNIFICANCE: These data provide a basis for understanding and ultimately treating several bone-related metabolic diseases.

Caffeine enhances osteoclast differentiation and maturation through p38 MAP kinase/Mitf and DC-STAMP/CtsK and TRAP pathway.

The consumption of caffeine from some common beverages has been associated with low bone mass by inducing urinary calcium loss and deceasing bone mineral density. However, the effect of caffeine on osteoclast differentiation is still unclear. Here, we demonstrate that caffeine directly enhances osteoclast differentiation and maturation. TRAP staining showed that the number of larger (>100 µm) osteoclastic cells as well as of TRAP-positive multinucleated cells was increased by caffeine treatment. Among the MAP kinases, caffeine specifically activated p38 MAP kinase, which in turn, controlled osteoclast differentiation and maturation. This is evidenced by the abolishment of activated p38 MAP kinase by pretreatment with SB203580, a p38-specific inhibitor, resulting in suppressed osteoclast differentiation and maturation that should be increased by caffeine. Caffeine significantly induced the expression of Mitf and pretreatment with SB203580 markedly suppressed the expression of Mitf induced by caffeine. Whereas it failed to regulate the expression of NFATc1 and Oscar, the expressions of Cathepsin K and TRAP were induced by caffeine treatment in primary preosteoclasts. Real-time PCR and luciferase assays showed that the increase of osteoclastic cell-cell fusion by caffeine was through the transcriptional up-regulation of DC-STAMP expression but not of Atp6v0d2. These results strongly suggest that caffeine directly enhances osteoclast differentiation and maturation through p38 MAP kinase activation, thus inducing Mitf expression and transcriptional activation of DC-STAMP, and finally CtsK and TRAP.

Partial characterization and immunostimulatory effect of a novel polysaccharide-protein complex extracted from Phellinus linteus.

Many polysaccharides isolated from mushroom are considered to be biological response modifiers and have been shown to enhance various immune responses in vivo and in vitro. We demonstrate that a novel polysaccharide-protein complex (PPC) extracted from Phellinus linteus was a potent immunomodulator. PPC had a molecular weight of approximately 73 kDa. It was composed of five different monosaccharides, predominantly D-glucose and D-mannose, in the molar ratio of 3:2, the main amino acid being aspartic acid. PPC had a unique mode of immunostimulation with regard to its cell-type specificity. PPC was found to markedly increase the proliferation of B cells, but not T cells. Although PPC and lipopolysaccharide (LPS) had a similar mode of action in B cells, they were differentiated by the fact that PPC-induced cellular activation was not inhibited by polymyxin B (PB), a specific inhibitor of LPS. PPC increased the cytokine production and nitric oxide (NO) from macrophages. PPC also enhanced the lytic death of NO-sensitive tumor cells, B16 melanoma, through the production of NO. In addition, PPC up-regulated the natural killer (NK) cell-mediated killing of tumor cells, YAC-1 lymphoma in vitro. These results suggest that PPC stimulated the tumoricidal activities of macrophages and NK cells, and induced the proliferation of B cells in vitro. This process may be the mechanism by which PPC produced its therapeutic effects.

Water extract of Cordyceps militaris enhances maturation of murine bone marrow-derived dendritic cells in vitro.

Water extract (WE) of Cordyceps militaris has been reported to produce antitumor and immunomodulatory activities in vivo and in vitro. However, the therapeutic mechanism has not been known. In this study, we investigated whether water extract of C. militaris induces the phenotypic and functional maturation of dendritic cells (DC). It profoundly increased CD40, CD54, CD80, CD86, and MHC class II expression in murine bone marrow (BM)-derived myeloid DC. Endocytosis was assessed by the uptake of FITC-dextran and FITC-albumin. The ability of unstimulated DC (UT-DC) to uptake dextran and albumin was higher than that of WE- or LPS-stimulated DC (LPS-DC). Also, UT-DC secreted a low concentration of IL-12, while WE- or LPS-DC secreted higher levels of IL-12 than UT-DC. WE not only formed morphologically mature DC and clusters, but also induced predominantly functional maturation. Moreover, WE is shown to promote the cytotoxicity of specific-cytotoxic T lymphocyte (CTL) induced by DC which were pulsed with P815 tumor-lysate during the stage of antigen presentation. These results suggest that DC maturation by WE can play a critical role in the improvement of the immunoregulatory function in patients with impaired host defense.