An unconventional VH1-2 antibody tolerates escape mutations and shows an antigenic hotspot on SARS-CoV-2 spike.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S) protein continues to evolve antigenically, impacting antibody immunity. D1F6, an affinity-matured non-stereotypic VH1-2 antibody isolated from a patient infected with the SARS-CoV-2 ancestral strain, effectively neutralizes most Omicron variants tested, including XBB.1.5. We identify that D1F6 in the immunoglobulin G (IgG) form is able to overcome the effect of most Omicron mutations through its avidity-enhanced multivalent S-trimer binding. Cryo-electron microscopy (cryo-EM) and biochemical analyses show that three simultaneous epitope mutations are generally needed to substantially disrupt the multivalent S-trimer binding by D1F6 IgG. Antigenic mutations at spike positions 346, 444, and 445, which appeared in the latest variants, have little effect on D1F6 binding individually. However, these mutations are able to act synergistically with earlier Omicron mutations to impair neutralization by affecting the interaction between D1F6 IgG and the S-trimer. These results provide insight into the mechanism by which accumulated antigenic mutations facilitate evasion of affinity-matured antibodies.

Pandemic Stress and Cyberbullying Among Adolescents During China's Outbreak of Omicron: Examining the Roles of Perceived Safety and Family Cohesion.

The COVID-19 pandemic posed risks to the psychosocial development of children and adolescents in the digital age. Under such a background, this study aims to examine the effects of pandemic stress on cyberbullying perpetration and victimization among Chinese adolescents, and to explore the mediator of perceived safety and the moderator of family cohesion underlying this association, during China's outbreak of Omicron. A sample of 822 adolescents was obtained from Taizhou in Zhejiang Province, China, based on a multistage cluster random sampling method. The results showed that pandemic stress was positively associated with cyberbullying perpetration and victimization. Moreover, pandemic stress negatively predicted perceived safety, which in turn, increased the probability of cyberbullying perpetration and victimization. Furthermore, family cohesion moderated the effects of pandemic stress on cyberbullying perpetration and victimization. This study contributes to practical implications for policy making and social work practices regarding how to protect adolescents from cyberbullying during the pandemic.

Additive Blending Effects on PEDOT:PSS Composite Films for Wearable Organic Electrochemical Transistors.

Organic electrochemical transistors (OECTs) employing conductive polymers (CPs) have gained remarkable prominence and have undergone extensive advancements in wearable and implantable bioelectronic applications in recent years. Among the diverse arrays of CPs, poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) is a common choice for the active-layer channel in p-type OECTs, showing a remarkably high transconductance for the high amplification of signals in biosensing applications. This investigation focuses on the novel engineering of PEDOT:PSS composite materials by seamlessly integrating several additives, namely, dimethyl sulfoxide (DMSO), (3-glycidyloxypropyl)trimethoxysilane (GOPS), and a nonionic fluorosurfactant (NIFS), to fine-tune their electrical conductivity, self-healing capability, and stretchability. To elucidate the intricate influences of the DMSO, GOPS, and NIFS additives on the formation of PEDOT:PSS composite films, theoretical calculations were performed, encompassing the solubility parameters and surface energies of the constituent components of the NIFS, PEDOT, PSS, and PSS-GOPS polymers. Furthermore, we conducted a comprehensive array of material analyses, which reveal the intricacies of the phase separation phenomenon and its interaction with the materials' characteristics. Our research identified the optimal composition for the PEDOT:PSS composite films, characterized by outstanding self-healing and stretchable capabilities. This composition has proven to be highly effective for constructing an active-layer channel in the form of OECT-based biosensors fabricated onto polydimethylsiloxane substrates for detecting dopamine. Overall, these findings represent significant progress in the application of PEDOT:PSS composite films in wearable bioelectronics and pave the way for the development of state-of-the-art biosensing technologies.

Effectiveness of Community-Based Programs on Aggressive Behavior Among Children and Adolescents: A Systematic Review and Meta-Analysis.

Adolescent aggressive behavior has increasingly become a central issue affecting the safety of both school campuses and the broader society. Despite the existence of numerous community interventions targeting this issue, there has been a paucity of efforts to consolidate the findings on the effectiveness of community-based programs in preventing aggressive behavior. This meta-analysis sought to address this gap by reviewing and assessing the impact of community-based initiatives on reducing adolescent aggression. A thorough search was carried out on 12 electronic databases: EBSCO, ERIC, PubMed, PsycINFO, MEDLINE, EMBASE, Scopus, Web of Science, ProQuest Dissertations and Theses, the China National Knowledge, Wanfang Databases, and China Science and Technology Journal Database. Sixteen studies were finalized, and meta-analyses were performed using a random effect model on RevMan v5.4 software developed by Cochrane. The analysis encompassed 16 published studies, involving a total of 2,585 participants. The key components of existing programs for aggression reduction included providing behavioral skills and training for adolescents, employing a problem-solving approach to address behavioral issues, offering psychological treatment, and emphasizing community supervision. The results indicate a significant positive effect of community-based interventions on aggression reduction (standardized mean difference = -0.26, 95% confidence intervals [-0.39, -0.13], Z = 3.84, p < .001). The subgroup analyses revealed that the intervention's effectiveness was moderated by the duration of the intervention, its theoretical foundation, and the sample size. This study furnishes empirical evidence supporting the enhancement of policies and practices to foster community engagement in mitigating aggressive behavior.

H1-antihistamine use and head and neck cancer risk in type 2 diabetes mellitus.

This study aimed to examine the association between the use of H1-antihistamines (AHs) and head and neck cancer (HNC) risk in patients with type 2 diabetes mellitus (T2DM). Data from the National Health Insurance Research Database of Taiwan were analyzed for the period from 2008 to 2018. A propensity-score-matched cohort of 54,384 patients each in the AH user and nonuser groups was created and analyzed using Kaplan-Meier method and Cox proportional hazards regression. The results showed that the risk of HNC was significantly lower in AH users (adjusted hazard ratio: 0.55, 95% CI: 0.48 to 0.64) and the incidence rate was also lower (5.16 vs. 8.10 per 100,000 person-years). The lower HNC incidence rate in AH users (95% CI: 0.63; 0.55 to 0.73) suggests that AH use may reduce the risk of HNC in T2DM patients.

Sensitive Detection of Sweat Cortisol Using an Organic Electrochemical Transistor Featuring Nanostructured Poly(3,4-Ethylenedioxythiophene) Derivatives in the Channel Layer.

In this study, we examined the influence of functionalized poly(3,4-ethylenedioxythiophene) (PEDOT) nanostructures decorated on the channel layer of an organic electrochemical transistor (OECT) for the detection of sweat cortisol, an adrenocorticosteroid stress hormone. The OECT device featured a bilayer channel confined by a PEDOT:polystyrenesulfonate (PSS) underlayer and a nanostructure-decorated upper layer engineered from the monomers EDOT-COOH and EDOT-EG3 through template-free electrochemical polymerization. This molecular design allowed antibody conjugation using 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide/N-hydroxysulfosuccinimide coupling through the carboxylic acid side chain, with EDOT-EG3 known to minimize nonspecific binding of biomolecules. We also engineered an OECT device having a channel area without any nanostructures to gain insight into the effect of the nanostructures on cortisol sensing. Our new nanostructure-embedded OECT device facilitated real-time detection of cortisol at concentrations ranging from 1 fg/mL to 1 µg/mL with a detection limit of 0.0088 fg/mL with good linearity (R2 = 0.9566), in addition to excellent selectivity toward cortisol among other structurally similar interfering compounds and high stability and reproducibility. With its rapid response for the detection of 100 ng/mL cortisol-spiked artificial sweat, this nanostructure-decorated OECT device has potential clinical practicality and utility in wearable sensors for future healthcare applications.

Factors associated with physicians' behaviours to prevent needlestick and sharp injuries.

OBJECTIVE: Needlestick and sharp injuries (NSIs) experienced by physicians have been identified as a major occupational hazard. Blood-borne pathogens resulting from the NSIs experienced by physicians pose severe physical and psychological threats to them, as well as people who are around them. However, there is little research focusing on physicians' behaviours to prevent NSIs. In the present study, we investigated the roles of safety climate, job demands experienced by physicians, and physicians' self-efficacy in affecting physicians' behaviours to prevent NSIs. METHODS: 401 physicians from four teaching hospitals in Northern Taiwan were recruited to participate in an anonymous survey. Among them, 189 physicians returned the completed survey with a response rate of 47.1%. RESULTS: Overall, respondents reported frequently engaging in NSI prevention behaviours. As expected, safety climate in hospitals and physicians' self-efficacy to prevent NSIs were significantly related to their behaviours to prevent NSIs (r = 0.22 and r = 0.33, respectively). The moderating analysis also revealed that physicians with high self-efficacy tended to engage in NSI prevention behaviours regardless of levels of job demand they experienced. In contrast to our expectation, however, physicians with low self-efficacy engaged in more NSI prevention behaviours when job demands were high than when the demands were low. CONCLUSIONS: Our findings show the important roles safety climate, job demands and self-efficacy play in shaping physicians' NSI prevention behaviours. Hospitals may consider improving safety climate via strengthening management commitments to NSIs prevention, reducing job demands by training physicians to proactively redesign their own jobs, and increasing physicians' self-efficacy via well-designed skill-based training.

Prokaryotic expression of chicken interferon-γ fusion protein and its effect on expression of poultry heat shock protein 70 under heat stress.

Interferons have attracted considerable attention due to their vital roles in the host immune response and low induction of antibiotic resistance. In this study, total RNA was extracted from spleen cells of chicken embryos inoculated with Newcastle disease vaccine, and the full-length chicken interferon-γ (ChIFN-γ) gene was amplified by RT-PCR. The full complementary DNA sequence of the ChIFN-γ gene was 495 bp long and was cloned into the prokaryotic expression vector pProEX™HTb . The plasmid was transformed into Escherichia coli DH5α and the expression of ChIFN-γ was induced by isopropyl ß-D-1-thiogalactopyranoside. Sodium dodecyl sulfate - polyacrylamide gel electrophoresis and Western blot results showed the expressed fusion protein had a molecular weight of approximately 18 kDa and was recognized by an anti-His mAb. Moreover, ChIFN-γ was found to demonstrate anti-viral activity in vitro. To test the in vivo function of ChIFN-γ in broilers under heat stress, a total of 100 broilers were randomly assigned to either a control group or a treated group, in which they were hypodermically injected with recombinant ChIFN-γ. Results demonstrated ChIFN-γ affects the messenger RNA expression levels of heat shock protein 70 (HSP70) in the heart and lung tissues, and decreases the concentration of HSP70 in serum. Therefore, we conclude recombinant ChIFN-γ can reduce heat stress to some extent in vivo.

Medicinal herbs Oenanthe javanica (Blume) DC., Casuarina equisetifolia L. and Sorghum bicolor (L.) Moench protect human cells from MPP+ damage via inducing FBXO7 expression.

BACKGROUND: The F-box protein 7 (FBXO7) mutations have been identified in families with early-onset parkinsonism and pyramidal tract signs, and designated as PARK15. In addition, FBXO7 mutations were found in typical and young onset Parkinson's disease (PD). Evidence has also shown that FBXO7 plays an important role in the development of dopaminergic neurons and increased stability and overexpression of FBXO7 may be beneficial to PD. PURPOSE: We screened extracts of medicinal herbs to enhance FBXO7 expression for neuroprotection in MPP+-treated cells. METHODS: Promoter reporter assay in HEK-293 cells was used to examine the cis/trans elements controlling FBXO7 expression and to screen extracts of medicinal herbs enhancing FBXO7 expression. MTT assay was performed to assess cell viability of MPP+-treated HEK-293/SH-SY5Y cells. In addition, proteasome activity, mitochondrial membrane potential and FBXO7/TRAF2/GATA2 protein expression were evaluated. RESULTS: We demonstrated that -202--57 region of the FBXO7 promoter is likely to contain sequences that are bound by positive trans protein factors to activate FBXO7 expression and GATA2 is the main trans protein factor enhancing FBXO7 expression. Extracts of medicinal herbs Oenanthe javanica (Blume) DC. (Umbelliferae), Casuarina equisetifolia L. (Casuarinaceae), and Sorghum bicolor (L.) Moench (Gramineae) improved cell viability of both MPP+-treated HEK-293 and SH-SY5Y cells, rescued proteasome activity in MPP+-treated HEK-293 cells, and restored mitochondrial membrane potential in MPP+-treated SH-SY5Y cells. These protection effects of herbal extracts are acting through enhancing FBXO7 and decreasing TRAF2 expression, which is probably mediated by GATA2 induction. CONCLUSION: Collectively, our study provides new targets, FBXO7 and its regulator GATA2, for the development of potential treatments of PD.

Determinants of workplace violence against clinical physicians in hospitals.

OBJECTIVES: Workplace violence in the health sector is a worldwide concern. Physicians play an essential role in health-care teamwork; thus, understanding how organizational factors influence workplace violence against physicians is critical. METHODS: A total of 189 physicians from three public hospitals and one private hospital in Northern Taiwan completed a survey, and the response rate was 47.1%. This study was approved by the institutional review board of each participating hospital. The 189 physicians were selected from the Taipei area, Taiwan. RESULTS: The results showed that 41.5% of the respondents had received at least one workplace-related physical or verbal violent threat, and that 9.8% of the respondents had experienced at least one episode of sexual harassment in the 3 months before the survey. Logistic regression analysis revealed that physicians in psychiatry or emergency medicine departments received more violent threats and sexual harassment than physicians in other departments. Furthermore, physicians with a lower workplace safety climate (OR=0.89; 95% CI=0.81-0.98) and more job demands (OR=1.15; 95% CI=1.02-1.30) were more likely to receive violent threats. CONCLUSIONS: This study found that workplace violence was associated with job demands and the workplace safety climate. Therefore, determining how to develop a workplace safety climate and ensure a safe job environment for physicians is a crucial management policy issue for health-care systems.

FBXO7 Y52C polymorphism as a potential protective factor in Parkinson's disease.

Mutations in the F-box only protein 7 gene (FBXO7), the substrate-specifying subunit of SCF E3 ubiquitin ligase complex, cause Parkinson's disease (PD)-15 (PARK15). To identify new variants, we sequenced FBXO7 cDNA in 80 Taiwanese early onset PD patients (age at onset ≤ 50) and only two known variants, Y52C (c.155A>G) and M115I (c.345G>A), were found. To assess the association of Y52C and M115I with the risk of PD, we conducted a case-control study in a cohort of PD and ethnically matched controls. There was a nominal difference in the Y52C G allele frequency between PD and controls (p = 0.045). After combining data from China [1], significant difference in the Y52C G allele frequency between PD and controls (p = 0.012) and significant association of G allele with decreased PD risk (p = 0.017) can be demonstrated. Upon expressing EGFP-tagged Cys52 FBXO7 in cells, a significantly reduced rate of FBXO7 protein decay was observed when compared with cells expressing Tyr52 FBXO7. In silico modeling of Cys52 exhibited a more stable feature than Tyr52. In cells expressing Cys52 FBXO7, the level of TNF receptor-associated factor 2 (TRAF2) was significantly reduced. Moreover, Cys52 FBXO7 showed stronger interaction with TRAF2 and promoted TRAF2 ubiquitination, which may be responsible for the reduced TRAF2 expression in Cys52 cells. After induced differentiation, SH-SY5Y cells expressing Cys52 FBXO7 displayed increased neuronal outgrowth. We therefore hypothesize that Cys52 variant of FBXO7 may contribute to reduced PD susceptibility in Chinese.

Modulation of mGluR-dependent MAP1B translation and AMPA receptor endocytosis by microRNA miR-146a-5p.

The translation of dendritic microtubule-associated protein 1B (MAP1B) is exaggerated upon group I mGluR activation leading to AMPA receptor (AMPAR) endocytosis and consequent long-term depression. However, the mechanisms of regulation of MAP1B protein synthesis in the mature dendrites remain unclear. Here we have identified miR-146a-5p that targets the 3' UTR of MAP1B mRNA and represses its translation. Inhibition of the endogenous miR-146a-5p in mouse cultured hippocampal neurons triggers an increase of the dendritic MAP1B protein as well as the internalization of AMPARs, resulting in a decline in synaptic transmission. Conversely, enforced expression of miR-146a-5p inhibits MAP1B translation and attenuates group I mGluR-induced AMPAR endocytosis. Moreover, siRNA-mediated knockdown of MAP1B recovers the impairment of synaptic transmission caused by inhibition of miR-146a-5p. These results reveal that miR-146a-5p modulates the synaptic plasticity via repression of MAP1B protein synthesis.

Transnasal endoscopic marsupialization of postoperative maxillary mucoceles: middle meatal antrostomy versus inferior meatal antrostomy.

The aim of this study was to evaluate the efficacy of transnasal endoscopic marsupialization as a treatment modality in patients with postoperative maxillary mucoceles and to compare the efficacy of marsupialization via middle meatal antrostomy with that of marsupialization via inferior meatal antrostomy. The study design was a retrospective clinical series and the setting was a tertiary referral center. After obtaining approval from the local ethics committee, we reviewed the medical records of 39 consecutive patients with postoperative maxillary mucoceles who were diagnosed and treated at the Department of Otolaryngology, Chang Gung Memorial Hospital, Taiwan, from 2004 to 2009. Transnasal endoscopic marsupialization was performed on 32 patients (34 sides) with postoperative maxillary mucoceles. All patients were followed for more than 12 months after surgery, and recurrence was noted in five patients (14.9%). Recurrence was experienced by five patients who underwent inferior meatal antrostomy and zero patients who underwent middle meatal antrostomy; thus, a statistically significant difference (p = 0.04) was observed. Transnasal endoscopic marsupialization is an effective modality for postoperative maxillary mucoceles and results in reduced morbidity. The use of middle meatal antrostomy in particular is preferred.

Traditional Chinese medicine, Xin-yi-san, reduces nasal symptoms of patients with perennial allergic rhinitis by its diverse immunomodulatory effects.

BACKGROUND: Perennial allergic rhinitis (AR) is a common health problem with a high prevalence rate of 43.6% in Taiwan. In our previous study, a mixed formula of Chinese herbs consisted of Xin-yi-san, Xiao-ging-long-tang, and Xiang-sha-liu-jun-zi-tang, exerted diverse immunomodulatory effects in the treatment of patients with perennial allergic rhinitis. OBJECTIVE: The aim of the present study was to determine whether Xin-yi-san (XYS) alone is effective in the treatment of AR and tried to explore its molecular mechanism of anti-allergic activity. METHODS: In a randomized double-blind study, 108 patients with AR received either XYS or a placebo for 3 months. The effectiveness of XYS was evaluated by nasal symptoms, nasal airflow resistance, nostril dissection area, and serum titer of specific IgE antibodies against house dust mite allergens. In addition, the production of T helper (Th) 1 (represented by interferon-gamma) and Th2 [represented by interleukin (IL)-4, IL-10, and IL-13] cytokines, the proinflammatory cytokine IL-8, soluble intercellular adhesion molecule (sICAM), and arachidonate metabolites prostagladin E(2) (PGE(2)) and leukotriene C(4) (LTC(4)) by polymorphonuclear neutrophils (PMNs) were compared before and after treatment between the two groups. RESULTS: XYS attenuated nasal symptoms (sneezing and rhinorrhea) and nasal congestion through reduction of nasal airflow resistance and increase in nostril dissection areas. We also found that XYS exerted diverse immunomodulatory effects, including suppression of serum IgE levels and increased production of IL-10, sICAM-1, and IL-8 compared to placebo group. However, XYS treatment did not affect the release of PGE(2) and LTC(4) from PMNs. CONCLUSIONS: This study originally provides the evidence that Xin-yi-san alone is an effective herb in the treatment of perennial allergic rhinitis.

Progesterone increases epirubicin's apoptotic effects in HepG2 cells by S phase cell cycle arrest.

BACKGROUND/AIMS: The use of chemotherapy in hepatocellular carcinoma is still controversial. The aim of this study was to investigate whether the combined use of epirubicin and progesterone has a synergistic effect on cell proliferation and apoptosis in HepG2 cells. METHODOLOGY: Different concentrations of epirubicin (0.1 microg/ml, 0.25 microg/ml and 0.5microg/ml) or progesterone (12.5 microM, 25 microM and 50 microM) were added to HepG2 cells either alone or in combinations consisting of different concentrations of the two. Their effects on HepG2 cells were studied by (1) XTT assay for analysis of cell proliferation, (2) 3H-Thymidine incorporation for DNA synthesis, (3) annexin V-FITC/ propidium iodide (PI) flowcytometery for cell apoptosis, (4) flowcytometry for cell cycle distributions, and (5) reverse transcription-polymerase chain reaction for expression of cell cycle modulator, cyclin D1. RESULTS: 50 microM progesterone increased both the cytotoxic and apoptotic effects of 0.1 microg/ml epirubicin on HepG2 cells at 48 hr culture due to 50 microM progesterone accumulated cells in S phase of the cell cycle and subsequently reduced cyclin D1 expression. These effects on HepG2 cells induced by this combination were comparable to those induced by 0.5 microg/ml epirubicin alone. CONCLUSIONS: In vitro, progesterone can increase the cytotoxicity and apoptosis induced by epirubicin on HepG2 cells.

Management of nasolabial cysts by transnasal endoscopic marsupialization.

OBJECTIVE: To evaluate hospitalization rates and duration of surgery associated with transnasal endoscopic marsupialization compared with sublabial excision in treating nasolabial cysts. DESIGN: Retrospective clinical series. SETTING: Large urban community hospital. PATIENTS: Consecutive sample of 57 patients with nasolabial cysts treated from January 1, 2000, to February 29, 2008. INTERVENTIONS: Sublabial excision in 23 patients (sublabial group) and transnasal endoscopic marsupialization in 34 patients (transnasal group). Among 57 patients, 47 underwent preoperative computed tomography. MAIN OUTCOME MEASURES: History, clinical presentation, preoperative condition, histopathologic findings, treatment, complications, and outcomes. RESULTS: The mean duration of surgery was 91.3 minutes in the sublabial group and 29.5 minutes in the transnasal group (P = .003). The hospitalization rate was 100% (23 of 23) in the sublabial group and 59% (20 of 34) in the transnasal group (P < .001). The medical costs were significantly lower in the transnasal group than in the sublabial group (P = .002). The follow-up period ranged from 6 to 85 months. Neither group of patients experienced any major complications or recurrences during the follow-up period. CONCLUSION: Transnasal endoscopic marsupialization is an effective treatment for nasolabial cysts, is less costly, and has fewer complications than sublabial excision.

[Development of an add-on module for the WHOQOL-BREF on patients with allergic rhinitis].

The purpose of this study was to develop an add-on module for the Taiwan-version WHOQOL-BREF for assessing the quality of life of people with allergic rhinitis. A cross-sectional survey design was used. In accordance with the seven steps for the development of population-specific modules of the WHOQOL, the instrument added new items on the basis of opinions of expert groups, including patients, families and physicians, to the Taiwan-version WHOQOL-BREF measure. The new questionnaire, comprising 52 items, was tested on 252 patients with allergic rhinitis. For content validity, each item was significantly correlated with the domain to which it belonged (r= .157-.715, p< .05); and each domain was significantly correlated with each other domain (r= .211-.535, p< .01). The construct validity was examined by means of the multitrait-multimethod method. The total score and the scores on the physiological and environmental subscales showed convergent validity with the score for IgE (r= -.317 - -.380, p< .01) and with the total score and the scores on the subscale of the allergic rhinitis symptom questionnaire (r= -.202 - -.360, p< .01). The scores on the body constitution subscale also showed convergent validity with the score for IgE (r= .329, p< .01) and with the total score and the scores on the subscale of the allergic rhinitis symptom questionnaire (r= .187-.261, p< .01). This result supports the appropriateness of this new questionnaire specifically for assessing the quality of life of people with allergic rhinitis. As regards concurrent validity, the total score was significantly correlated with the score of all subscales in the Medical Outcomes Study Short Form Taiwan-version (SF-36) (r= .256-.542, p< .01). The internal consistency reliability established by Cronbach's alpha ranged for each domain from .73-.81. The test-retest reliability correlated for each domain of the instrument was .719-.794 (p< .01). In conclusion, the add-on module developed in this paper for the Taiwan-version WHOQOL-BREF for patients with allergic rhinitis is reliable, valid and specific.

Perineural invasion of sinonasal lymphoma: a rare cause of trigeminal neuropathy.

Trigeminal neuropathy is characterized by sensory disturbance of the division of trigeminal nerve, and sometimes is associated with pain. Trigeminal neuropathy secondary to perineural invasion of sinonasal lymphoma is extremely rare. Likewise, sinonasal lymphoma is infrequently demonstrated initially with cranial neuropathy. The present case served to broaden the differential diagnosis of secondary trigeminal neuropathy and to alert clinicians to cautiously assess perineural spread of occult neoplasm in sinonasal tract and larynx or pharynx for cases with evolving trigeminal neuropathy or even other cranial nerve neuropathy in which no definite cause is identified.

HIV infection initially presenting as sinonasal Burkitt's lymphoma.

Burkitt's lymphoma is a common comorbidity of infection with the human immunodeficiency virus, but rarely the initial clinical manifestation of undiagnosed AIDS, especially for the otolaryngologist. We report the case of a patient with recalcitrant rhinosinusitis subsequently diagnosed with sinonasal Burkitt's lymphoma and HIV.

Oncocytic schneiderian papilloma found in a recurrent chronic paranasal sinusitis.

Oncocytic schneiderian papilloma (OSP), also known as cylindrical cell papilloma, is a rare benign sinonasal neoplasm. Due to its rare incidence, this disease is not well-understood by clinicians. The probability of malignancies arising in OSP is not low but they are rarely encountered in clinical practice. To the best of our knowledge, there is no documentation of OSP associated with recurrent chronic paranasal sinusitis (CPS). We hereby report an unusual case of OSP in a 28 year-old man which was first diagnosed and treated as recurrent chronic paranasal sinusitis. After three surgeries, OSP was revealed in the pathological findings and the tumor was completely resected endoscopically in the fourth operation. There was no sign of recurrence after two years of follow-up. A thorough review of histopathological slides from the first two surgeries showed no sign of OSP in these tissue sections. We present this case to remind clinicians that OSP can be found with inflammatory polyps in CPS, and it is easily overlooked clinically. Nevertheless, sufficient alertness from both the surgeon and pathologist is the cornerstone for the proper diagnosis and appropriate treatment of this rare nasal neoplasm.