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Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) share some similar pathological mechanisms. In current study, we intend to investigate the impact of AR on CRS. In addition, we explored the efficacy of erythromycin (EM) treatment on CRS mice with or without AR (CRSwoAR, CRSwAR). Study subjects were divided into control, CRSwoAR, and CRSwAR groups. Experimental mice were divided similarly into control, CRSwoAR, and CRSwAR groups. In addition, CRS mice were treated with EM at 0.75, 7.5, or 75 mg/kg or with dexamethasone (Dex) at 1 mg/kg. In our results, allergy exacerbates inflammation that was evident in nasal histology and cytokine expression both in patients and in mice with CRS. Dex 1 mg/kg, EM 7.5 or 75 mg/kg treatments significantly inhibited serum IgE and IgG2a in CRS mice. EM-treated CRS mice had significantly elevated IL-10 levels and had a reversal of Th-1/Th-2 cytokine expression in nasal-associated lymphoid tissue. MUC5AC expressions were significantly reduced in the 7.5 or 75 mg/kg EM-treated mice compared with untreated mice. EM showed inhibitions on immunoglobulin production and mucus secretion stronger than Dex. We concluded that comorbid AR enhanced inflammation of CRS. EM and Dex treatments showed similar anti-inflammatory effects on CRS but through partly different mechanisms.
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Antibacterianos/uso terapéutico , Eritromicina/uso terapéutico , Mucosa Nasal/metabolismo , Rinitis Alérgica/complicaciones , Sinusitis/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Animales , Antibacterianos/farmacología , Antiinflamatorios/farmacología , Antiinflamatorios/uso terapéutico , Enfermedad Crónica , Citocinas/metabolismo , Dexametasona/farmacología , Dexametasona/uso terapéutico , Evaluación Preclínica de Medicamentos , Eritromicina/farmacología , Femenino , Humanos , Inmunoglobulina E/metabolismo , Masculino , Ratones Endogámicos BALB C , Persona de Mediana Edad , Moco/metabolismo , Rinitis Alérgica/tratamiento farmacológico , Rinitis Alérgica/metabolismo , Sinusitis/tratamiento farmacológico , Sinusitis/metabolismo , Adulto JovenRESUMEN
Objectives: Luteolin is the active component of Perilla frutescens, an herb for the treatment of allergy in Asia. In this study, we aimed to investigate the effects and mechanisms of luteolin treatment. Methods: BALB/c mice sensitized with house dust mite (HDM) to induce allergic rhinitis (AR), and treated with dexamethasone or luteolin. In addition, mononuclear cells from peripheral blood (PBMC) of AR patients were co-cultured with dexamethasone or luteolin, and were re-stimulated with HDM. Results: Luteolin-treated mice had decreased allergic symptoms, and serum HDM-specific IgE when compared to the untreated group. Flow cytometric analyses of splenocytes and nasal lymphoid tissues from AR mice found that luteolin decreased CD4+ IL-4-secreting T cells when compared to those from vehicle treated AR mice. Histopathology sections showed reduced infiltration of eosinophils and decreased mucus secretion of mouse nasal epithelium. In the in vitro study, the results showed that luteolin reduced the percentage of CD4+ IL-4-secreting splenocytes expression was through reducing expression of pSTAT6 and GATA3. PBMCs from AR patients pretreated with luteolin could decrease percentage of CD4+ IL-4-secreting cells. Conclusion: Our study identified that luteolin attenuates allergic nasal inflammation via inhibition of IL-4 production, which supports the potential pharmaceutical application of luteolin treatment for AR.
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BACKGROUND: To investigate the benefits of adjunctive Chinese herbal medicine (CHM) for patients with nasopharyngeal carcinoma (NPC). METHODS: We included all patients diagnosed with NPC during 1997-2009 and followed until 2011 in Taiwan. We used 1:1 frequency matching by age, sex, comorbidity, conventional treatment, and index year to compare the CHM users and non-CHM users (n = 2542 each). The prescribed CHM was further investigated with regard to its cytotoxicity. RESULTS: Compared with non-CHM users, adjunctive CHM users had a lower hazard ratio of mortality risk, and a better survival probability. Gan-Lu-Yin (GLY) was the most commonly prescribed CHM, and it reduced cell viability, inhibited tumor proliferation, and induced apoptosis through the poly (ADP-ribose) polymerase and caspase-3-dependent pathway in human NPC TW01 cells. Oral administration of GLY retarded NPC-TW01 tumor growth in the xenograft nude mouse model. CONCLUSION: Real-world data and laboratory experiments implied that adjunctive CHM might be beneficial for NPC patients.
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Carcinoma/terapia , Medicamentos Herbarios Chinos/farmacología , Medicamentos Herbarios Chinos/uso terapéutico , Neoplasias Nasofaríngeas/terapia , Adulto , Animales , Apoptosis/efectos de los fármacos , Carcinoma/mortalidad , Carcinoma/patología , Ciclo Celular/efectos de los fármacos , Línea Celular Tumoral , Supervivencia Celular/efectos de los fármacos , Quimioterapia Adyuvante , Femenino , Humanos , Masculino , Análisis por Apareamiento , Ratones Endogámicos BALB C , Persona de Mediana Edad , Neoplasias Nasofaríngeas/mortalidad , Neoplasias Nasofaríngeas/patología , Modelos de Riesgos Proporcionales , Radioterapia Adyuvante , Adulto Joven , Proteína X Asociada a bcl-2/efectos de los fármacos , Proteína X Asociada a bcl-2/metabolismo , Proteína bcl-X/efectos de los fármacos , Proteína bcl-X/metabolismoRESUMEN
OBJECTIVES: To study the effects of zinc and steroid in the treatment of traumatic anosmia. STUDY DESIGN: A prospective, randomized study. SETTING: Academic medical center. SUBJECTS AND METHODS: Patients with a clear history of loss of smell after head injury and whose thresholds were -1 measured by the phenyl ethyl alcohol threshold test were included in this study from January 2010 to May 2013. They were randomly divided into 4 groups. Patients in group 1 were treated with zinc gluconate for a month and high-dose prednisolone with tapering for 2 weeks. Those in group 2 took only zinc gluconate, and those in group 3 took only prednisolone. Patients in group 4 did not take any medicine. All patients were followed up by phenyl ethyl alcohol threshold testing, and magnetic resonance imaging was performed to measure the volume of olfactory bulbs. RESULTS: Thirty-nine patients in group 1, 35 in group 2, 34 in group 3, and 37 in group 4 completed the study. The recovery of olfactory function was observed in 11 patients (28.2%) in group 1, in 9 (25.7%) in group 2, in 4 (11.8%) in group 3, and in 1 (2.7%) in group 4. The recovery rates of olfactory function of groups 1 and 2 were significantly higher than the recovery rate of group 4. The volume of olfactory bulbs was not significantly different between those with and without improved olfactory function. CONCLUSION: Our results show that zinc gluconate has a promising effect in treating traumatic anosmia.
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Glucocorticoides/administración & dosificación , Gluconatos/uso terapéutico , Trastornos del Olfato/tratamiento farmacológico , Prednisolona/administración & dosificación , Zinc/uso terapéutico , Adulto , Anciano , Traumatismos Craneocerebrales/complicaciones , Quimioterapia Combinada , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Trastornos del Olfato/etiología , Estudios Prospectivos , Adulto JovenRESUMEN
OBJECTIVES: Allergic rhinitis (AR) is a common allergic disorder in children, some of whom seek complementary treatments, including acupuncture and Chinese herbs. Little, however, is known about the treatment of pediatric AR with traditional Chinese medicine (TCM). To characterize TCM use in pediatric AR, we conducted a nationwide population-based study. METHODS: We screened one million randomly sampled beneficiaries of the National Health Insurance Program in Taiwan from 2002 to 2010 to identify children <18 years of age with newly diagnosed allergic rhinitis (ICD-9 code 477.9). The subjects were categorized according to their use of TCM. RESULTS: We identified 97,401 children newly diagnosed with AR for inclusion in the study. Among these children, 63.11% (N=61,472) had used TCM. There were significantly more TCM users than non-users among school-age children and adolescents (P<0.001). Most (99.1%) pediatric TCM users received Chinese herbal remedies (99.1%); only 0.9% received acupuncture or manipulative therapies. Xin-Yi-Qing-Fei-Tang (Magnolia Flower Lung-Clearing Decoction) was the most frequently prescribed TCM formulation (23.44%), and the most commonly prescribed single herb was Chan-Tui (Periostracum cicadae; 13.78%). Regarding syndrome differentiation (ZHENG) according to TCM theory, prescriptions for the Cold Syndrome exceeded those for the Hot Syndrome throughout the year in Taiwan. CONCLUSIONS: We found that approximately two-thirds of pediatric AR patients were prescribed TCM treatments in Taiwan. Further research is warranted to examine the efficacy and safety of TCM for pediatric AR patients.
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Medicamentos Herbarios Chinos/uso terapéutico , Medicina Tradicional China/estadística & datos numéricos , Rinitis Alérgica/terapia , Terapia por Acupuntura/estadística & datos numéricos , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Manipulaciones Musculoesqueléticas/estadística & datos numéricos , Programas Nacionales de Salud , Rinitis Alérgica/diagnóstico , Rinitis Alérgica/epidemiología , Taiwán/epidemiologíaRESUMEN
BACKGROUND: Chronic rhinosinusitis (CRS) is a chronic illness with a high prevalence worldwide. The purpose of this study was to investigate the characteristics of adjunctive traditional Chinese medicine (TCM) use in patients with CRS. METHODS: Data were retrieved from a dataset made available by the Taiwan National Health Insurance Research Database (NHIRD) containing the medical records of 1,000,000 randomly sampled beneficiaries insured in the year 2000. Patients newly diagnosed with CRS in the year 2000 were enrolled, and their medical records during the period 2000 to 2011 were collected and analyzed. RESULTS: A total of 14,806 CRS subjects were enrolled in this study: 10,512 were non-TCM users and 4294 were TCM users. TCM group had a significantly higher proportion of females, were younger, and a greater proportion lived in urban areas compared with the non-TCM group (all p < 0.0001). Ninety-seven percent (97%) of the TCM users received herbal remedies. The most common Chinese herbal formula used was Xin-Yi-Qing-Fei-Tang and the most commonly used single herb was Baizhi. The hazard ratio (HR) for functional endoscopic sinus surgery (FESS) was 0.17 for TCM users (95% confidence interval [CI], 0.15 to 0.20) compared with non-TCM users after adjusting for age, sex, urbanization, and comorbidities. CONCLUSION: Our investigation found that 29% of CRS patients used TCM in addition to Western medical treatment. A lower proportion of patients in the TCM group underwent ESS compared with that in the non-TCM group. These findings may be of value in further studies evaluating the efficacy and safety of TCM use in CRS patients.
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Medicina Tradicional China/métodos , Rinitis/terapia , Sinusitis/terapia , Terapia por Acupuntura/métodos , Adulto , Anciano , Atención Ambulatoria/estadística & datos numéricos , Enfermedad Crónica , Terapia Combinada , Medicamentos Herbarios Chinos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Estudios Retrospectivos , Taiwán , Resultado del Tratamiento , Adulto JovenRESUMEN
Rhinitis is a common medical condition and can seriously impact patients' quality of life. The objective of this study was to investigate the association between disease-specific quality of life and use of complementary and alternative medicine (CAM) modalities among Taiwanese rhinitis patients. A cross-sectional survey was undertaken at the outpatient department of otolaryngology in a medical center in Taiwan. Sociodemographic information, disease-specific quality of life (Chinese version of the 31-item Rhinosinusitis Outcome Measure, CRSOM-31), and previous use of CAM modalities for treatment of rhinitis of the patients were ascertained. Factor analysis was performed to reduce the number of CAM modalities. The resulting factors were analyzed for their association with CRSOM-31 score using linear regression analyses. Results from the multiple linear regression analyses indicated that Factor 1 (traditional Chinese medicine), Factor 2 (mind-body modalities), Factor 3 (manipulative-based modalities), female sex, and smoking were significantly associated with a worse disease-specific quality of life. In conclusion, various CAM modalities, female sex, and smoking were independent predictors of a worse disease-specific quality of life in Taiwanese patients with rhinitis.
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PURPOSE: To investigate the effects of adjuvant chemotherapy in nasopharyngeal carcinoma (NPC) patients with persistently detectable plasma Epstein-Barr virus DNA (pEBV DNA) after curative radiation therapy plus induction/concurrent chemotherapy. METHODS AND MATERIALS: The study population consisted of 625 NPC patients with available pEBV DNA levels before and after treatment. Eighty-five patients with persistently detectable pEBV DNA after 1 week of completing radiation therapy were eligible for this retrospective study. Of the 85 patients, 33 were administered adjuvant chemotherapy consisting of oral tegafur-uracil (2 capsules twice daily) for 12 months with (n=4) or without (n=29) preceding intravenous chemotherapy of mitomycin-C, epirubicin, and cisplatin. The remaining 52 patients who did not receive adjuvant chemotherapy served as the control group. RESULTS: Baseline patient characteristics at diagnosis (age, sex, pathologic type, performance status, T classification, N classification, and overall stage), as well as previous treatment modality, were comparable in both arms. After a median follow-up of 70 months for surviving patients, 45.5% (15 of 33 patients) with adjuvant chemotherapy and 71.2% (37 of 52 patients) without adjuvant chemotherapy experienced tumor relapses (P=.0323). There were a significant reduction in distant failure (P=.0034) but not in local or regional recurrence. The 5-year overall survival rate was 71.6% for patients with adjuvant chemotherapy and 28.7% for patients without adjuvant chemotherapy (hazard ratio 0.27; 95% confidence interval 0.17-0.55; P<.0001). CONCLUSIONS: Our retrospective data showed that adjuvant chemotherapy can reduce distant failure and improve overall survival in NPC patients with persistently detectable pEBV DNA after curative radiation therapy plus induction/concurrent chemotherapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , ADN Viral/sangre , Herpesvirus Humano 4/genética , Neoplasias Nasofaríngeas/tratamiento farmacológico , Neoplasias Nasofaríngeas/virología , Adulto , Biomarcadores/sangre , Quimioterapia Adyuvante/métodos , Quimioterapia Adyuvante/mortalidad , Cisplatino/administración & dosificación , Combinación de Medicamentos , Epirrubicina/administración & dosificación , Femenino , Fluorouracilo/administración & dosificación , Humanos , Quimioterapia de Inducción/métodos , Leucovorina/administración & dosificación , Masculino , Persona de Mediana Edad , Mitomicina/administración & dosificación , Neoplasias Nasofaríngeas/mortalidad , Neoplasias Nasofaríngeas/radioterapia , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/virología , Radioterapia Conformacional/métodos , Estudios Retrospectivos , Tegafur/uso terapéutico , Resultado del Tratamiento , Uracilo/uso terapéuticoRESUMEN
Rhinitis is a common upper airway disease and can have great impact on patients' quality of life. Factors associated with the use of common treatment modalities among 279 Taiwanese rhinitis patients from the outpatient department of otolaryngology in a medical center were investigated using a cross-sectional survey study. Results from multiple logistic regression analysis, adjusted for etiologies of rhinitis, revealed that males were associated with surgical intervention (OR = 2.11, P = 0.009). Lower educational level was associated with oral (OR = 2.31, P = 0.024) and topical medications (OR = 2.50, P = 0.005). Poor or fair general health status was associated with topical medications (OR = 4.47, P = 0.001), whereas very good or excellent general health status was inversely associated with surgical intervention (OR = 0.32, P = 0.002). Smoking was associated with the use of nasal irrigation (OR = 2.72, P = 0.003). Worse disease-specific quality of life was associated with oral medications (OR = 2.46, P = 0.010) and traditional Chinese medicine (OR = 5.43, P < 0.001). In conclusion, the use of different treatment modalities for rhinitis was associated with different combinations of independent factors.
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BACKGROUND: This study was designed to examine the efficacy of Chinese herbal medicine (CHM) in the treatment of chronic rhinosinusitis (CRS) without nasal polyps. METHODS: Patients with CRS without nasal polyps were enrolled in the study. Before treatment, they were evaluated by the Taiwanese version of the 20-item Sino-Nasal Outcome Test (TWSNOT-20), nasal endoscopy, saccharin test, and bacterial culture. Then, they were randomized to take CHM (Tsang-Erh-San extract granules and Houttuynia extract powder) or erythromycin for 8 weeks. After treatment, they were evaluated again by the TWSNOT-20, nasal endoscopy, saccharin test, and bacterial culture. RESULTS: Fifty-three patients completed the study with 26 in the CHM group and 27 in the erythromycin group. In both the CHM and the erythromycin groups, TWSNOT-20 scores significantly decreased after treatment, but the decrease was not significantly different between the two groups. However, the saccharin transit times were shortened in more patients in the CHM group than in patients in the erythromycin group. CONCLUSION: Our results showed CHM had an efficacy similar to that of macrolides in the treatment of CRS without nasal polyps. However, a placebo effect remained possible in both treatment groups.
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Antibacterianos/uso terapéutico , Medicamentos Herbarios Chinos/uso terapéutico , Eritromicina/uso terapéutico , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/aislamiento & purificación , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pólipos Nasales/tratamiento farmacológico , Rinitis/microbiología , Sinusitis/microbiologíaRESUMEN
Background. We aimed to apply the ZHENG identification to provide an easy and useful tool to stratify the patients with allergic rhinitis (AR) through exploring the correlation between the quantified scores of AR symptoms and the TCM ZHENGs. Methods. A total of 114 AR patients were enrolled in this observational study. All participants received the examinations of anterior rhinoscopy and acoustic rhinometry. Their blood samples were collected for measurement of total serum immunoglobulin E (IgE), blood eosinophil count (Eos), and serum eosinophil cationic protein (ECP). They also received two questionnaire to assess the severity scores of AR symptoms and quantified TCM ZHENG scores. Multiple linear regression analysis was used to determine explanatory factors for the score of AR manifestations. Results. IgE and ECP level, duration of AR, the 2 derived TCMZHENG scores of "Yin-Xu - Yang-Xu", and "Qi-Xu + Blood-Xu" were 5 explanatory variables to predict the severity scores of AR symptoms. The patients who had higher scores of "Yin-Xu - Yang-Xu" or "Qi-Xu + Blood-Xu" tended to manifest as "sneezer and runner" or "blockers," respectively. Conclusions. The TCM ZHENG scores correlated with the severity scores of AR symptoms and provided an easy and useful tool to stratify the AR patients.
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BACKGROUND: A number of herbal preparations have been reported being used as adjunctive treatment of patients with chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS). This study was designed to examine the efficacy of Chinese herbal medicine (CHM) in the postoperative care of post-FESS patients. METHODS: Patients with CRS who underwent FESS were prospectively enrolled in the study. Before surgery, they were evaluated by various methods, including the Chinese version of the Rhinosinusitis Outcome Measure (CRSOM-31), nasal endoscopy, acoustic rhinometry, and computed tomography (CT). After surgery, they were randomized to take CHM (Tsang-Erh-San extract granules and Houttuynia extract powder) for 8 weeks, amoxicillin for 4 weeks, or placebo. They were revaluated by CRSOM-31, nasal endoscopy, and acoustic rhinometry at 8 weeks and by CT at 12 weeks after surgery. RESULTS: Ninety-seven patients (33 in the CHM group, 34 in the amoxicillin group, and 30 in the placebo group) completed the study. In the CHM group, CRSOM-31 and endoscopic scores significantly decreased, and the second minimal cross-sectional area of the nasal cavity measured by acoustic rhinometry significantly increased after treatment. In the amoxicillin and placebo groups, CRSOM-31, endoscopic, and CT scores significantly decreased after treatment. However, there were no significant differences in subjective and objective treatment outcomes among three groups of patients. CONCLUSION: Our results showed there was no significant benefit of using CHMs (Tsang-Erh-San extract granules and Houttuynia extract powder) or oral amoxicillin in post-FESS care of CRS patients. Additional investigation is necessary for post-FESS care.
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Amoxicilina/administración & dosificación , Medicamentos Herbarios Chinos/administración & dosificación , Extractos Vegetales/administración & dosificación , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Adolescente , Adulto , Anciano , Amoxicilina/efectos adversos , Enfermedad Crónica , Medicamentos Herbarios Chinos/efectos adversos , Endoscopía , Femenino , Houttuynia , Humanos , Masculino , Persona de Mediana Edad , Extractos Vegetales/efectos adversos , Cuidados Posoperatorios , Estudios Prospectivos , Rinitis/fisiopatología , Rinitis/cirugía , Sinusitis/fisiopatología , Sinusitis/cirugía , Encuestas y CuestionariosRESUMEN
BACKGROUND/PURPOSE: Pollen allergy is believed to be less common in East Asia, Latin America, and tropical areas. The purpose of this study was to understand the role of pollen allergy in Taiwan. METHODS: Patients with clinically diagnosed allergic rhinitis were enrolled. All subjects received a 30-item skin test panel that included perennial allergens (house dust mix, Dermatophagoides pteronyssinus, Dermatophagoides farinae, dog epithelium, cat hairs, cockroach mix, and Candida albicans) and pollen allergens (acacia, pine mix, eucalyptus, beefwood, juniper mix, willow, mulberry mix, pepper tree, cedar, Johnson grass, Bermuda grass, ragweed mix, Timothy grass, spiny pigweed, cocklebur, sage mix, sheep sorrel, dog fennel, pigweed mix, English plantain, castor bean, alfalfa, and dandelion). RESULTS: A total of 419 patients were recruited. A total of 313 (74.7%) had a positive skin test. A total of 288 patients (68.7%) were sensitive to perennial allergens, and 11 8 patients (28.2%) were sensitive to pollen allergens. However, 93 pollen-sensitive patients were also sensitive to perennial allergens, and only 25 were sensitive to pollen allergens alone. The most common allergens were D. pteronyssinus, D. farinae, house dust mix, and cockroach, but the most common pollen allergens were spiny pigweed, Johnson grass, and sheep sorrel. All nasal symptoms tended to be more severe in patients who were sensitive to perennial allergens than in those who were sensitive to pollen allergens alone. CONCLUSION: Most patients with allergic rhinitis in Taiwan are sensitive to perennial allergens, and pollens are a less common allergen.