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.

[Dynamic orthosis with Shujinxi (, SJX) external granule for the treatment of collateral ligament contracture of metacarpophalangeal joint].

OBJECTIVE: To explore clinical efficacy of hand power device and Shujinxi (, SJX) external granule in treating collateral ligament contracture of metacarpophalangeal joint. METHODS: Fifty patients with collateral ligament contracture of metacarpophalangeal joint from June 2017 to January 2019 were divided into experimental and control group, 25 patients in each group. In experimental group, there were 17 males and 8 females aged from 19 to 63 years old with an average of (40.53±9.42) years old; 36 affected fingers; the courses of disease ranged from 23 to 82 days with an average of (52.37± 11.20) days; treated with hand power device and SJX external granule. In control group, there were 15 males and 10 females aged from 21 to 58 years old with an average of (42.11±8.36) years old; 32 affected fingers; the courses of diseases ranged from 18 to 71 days with an average of (48.24±12.50) days; treated with loose training of metacarpophalangeal joints. Symptoms of pain of affected finger, flexion and extension function were observed between two groups, VAS score was used to evaluate relieve degree of pain, grip size was used to evaluate recovery of grip, total active motion was applied to assess recovery of metacarpophalangeal joints, the second operation and occurrence of complications between two groups were compared. RESULTS: All patients were followed up about 8 weeks. VAS score, total active motion of metacarpophalangeal joints and grip of affected finger before and after treatment in experimental group were (4.22±1.09) point vs (1.98±1.01) point ,(17.40±6.31) ° vs (70.95±7.68) ° ,(4.83±3.09) kg vs (23.17±10.54) kg respectively, while in control group were (4.66±0.95) point vs (2.84± 1.06) point ,(16.25±5.66) ° vs (59.14±10.61) ° ,(5.06±4.05) kg vs (16.25±9.66) kg; there were statistical difference between two groups before and after treatment, and these items in experimental group after treatment were higher than that of control group (P<0.05) . There were no complicationsoccurred betweentwo groups. Onepatientinexperimentalgroup and 8 patients in controlgroupneededto bethesecondoperation, andhadsignificancedifference (P<0.05) . CONCLUSION: Handpowerdevice and SJXexternalgranulecouldobviouslyrelievesymptomsof pain of affected finger, improve recovery of grip strength, increase total active motion, and has good safety. It is an effective method for treating for the treatment of collateral ligament contracture of metacarpophalangeal joint.