Identification of hub genes and immune cell infiltration characteristics in chronic rhinosinusitis with nasal polyps: Bioinformatics analysis and experimental validation.

The aim of our study is to reveal the hub genes related to the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) and their association with immune cell infiltration through bioinformatics analysis combined with experimental validation. In this study, through differential gene expression analysis, 1,516 upregulated and 1,307 downregulated DEG were obtained from dataset GSE136825 of the GEO database. We identified 14 co-expressed modules using weighted gene co-expression network analysis (WGCNA), among which the most significant positive and negative correlations were MEgreen and MEturquoise modules, containing 1,540 and 3,710 genes respectively. After the intersection of the two modules and DEG, two gene sets-DEG-MEgreen and DEG-MEturquoise-were obtained, containing 395 and 1,168 genes respectively. Through GO term analysis, it was found that immune response and signal transduction are the most important biological processes. We found, based on KEGG pathway enrichment analysis, that osteoclast differentiations, cytokine-cytokine receptor interactions, and neuroactive ligand-receptor interactions are the most important in the two gene sets. Through PPI network analysis, we listed the top-ten genes for the concentrated connectivity of the two gene sets. Next, a few genes were verified by qPCR experiments, and FPR2, ITGAM, C3AR1, FCER1G, CYBB in DEG-MEgreen and GNG4, NMUR2, and GNG7 in DEG-MEturquoise were confirmed to be related to the pathogenesis of CRSwNP. NP immune cell infiltration analysis revealed a significant difference in the proportion of immune cells between the NP group and control group. Finally, correlation analysis between target hub genes and immune cells indicated that FPR2 and GNG7 had a positive or negative correlation with some specific immune cells. In summary, the discoveries of these new hub genes and their association with immune cell infiltration are of great significance for uncovering the specific pathogenesis of CRSwNP and searching for disease biomarkers and potential therapeutic targets.

[Measurement of nasal septum area in 128 Chinese patients with nasal septum deviation].

Objective:Establish the anatomical parameters of the nasal septum and the area of each component in patients with nasal septum deviation, for the sake of guiding the scope of surgical resection for correction of nasal septum deviation. Methods:This is a retrospective study of 128 cases of sinus computer tomography images of patients with nasal septum deviation, marked 9 nasal septal anatomical locations, measured the area of the nasal septum and its components, and analyzed the trend of the percentage of the area of the nasal septum cartilage in the total area of the nasal septum with age. Results:The total area of the nasal septum in the 128 patients with nasal septum deviation is: （2951.96±305.91） mm², the area of nasal septal cartilage: （961.89±229.64） mm², the area of the vertical ethmoid plate: （1123.96±214.17） mm², the area of the vomerine: （652.77±108.09） mm². The area of male septum is larger than that of female. As age increases, the nasal septal cartilage gradually decreases, and the percentage of the nasal septal cartilage area in the total area of the nasal septum gradually decreases. Conclusion:Elderly people who undergo nasal septum correction should be carefully considered to grasp the scope of resection, and the influence of gender on the area of nasal septum should also be paid attention.

Differential expression profile of plasma exosomal microRNAs in chronic rhinosinusitis with nasal polyps.

Exosomes mediate inflammation and immune responses. The aim of the study was to examine the expression profiles of plasma exosomal microRNAs (miRNAs) and analyze their target gene functions in participants with chronic rhinosinusitis with nasal polyps (CRSwNP). We measured plasma exosomal miRNAs in five patients with CRSwNP and five controls. Transcripts per million (TPM) was used to assess miRNAs expression and the Benjamini-Hochberg procedure was employed for multiple comparisons correction. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene ontology (GO) analyses revealed biological annotation and functional prediction of target genes. Compared with controls, we found that 159 exosomal miRNAs were differentially expressed by miRNA sequencing in CRSwNP. The top three upregulated miRNAs were novel_miR_677, novel_miR_1037, and novel_miR_79, while the top three downregulated miRNAs were novel_miR_192, novel_miR_1022, and novel_miR_4. The target functions in the GO and KEGG analyses included axon guidance, extracellular matrix (ECM)-receptor interaction, protein digestion and absorption, the calcium, the Hippo, the Notch, the ErbB, the cAMP signaling pathway, and focal adhesion. This study describes the dissection of plasma exosomal miRNA profiling in CRSwNP. Our findings may provide a certain basis for further mechanism research and exploration of diagnostic values.

Comparison of Bioabsorbable Steroid-Eluting Sinus Stents Versus Nasopore After Endoscopic Sinus Surgery: A Multicenter, Randomized, Controlled, Single-Blinded Clinical Trial.

OBJECTIVES: The aim of this study was to compare the efficacy of bioabsorbable steroid-eluting sinus stents versus absorbable Nasopore packs after endoscopic sinus surgery (ESS) for the treatment of chronic rhinosinusitis (CRS). METHODS: One hundred eighty-one patients with CRS who underwent ESS were randomly assigned to receive a steroid-eluting sinus stent in one ethmoid sinus cavity, whereas the contralateral control side received a Nasopore pack. Endoscopic evaluations were performed 14, 30, and 90 days after the ESS. Postoperative intervention, polyp formation, adhesions, and middle turbinate (MT) position were assessed as efficacy outcomes. RESULTS: The stents were successfully deployed in all 181 sinuses. Thirty days after the ESS, the stents significantly reduced the need for surgical intervention compared to the Nasopore (P < .0001). The percentage of cases with polyp formation was significantly lower on the stent sides compared with the Nasopore sides (P < .0001) at 14, 30, and 90 days after ESS. The percentage of severe adhesion was significantly lower on the stents sides than on the Nasopore sides at postoperative day 90 (P = .0003), whereas they were not significantly lower at postoperative days 14 and 30. There were no significant differences between the stent sides and the Nasopore sides regarding the frequency of MT lateralization at all end points. No device-related adverse events occurred. CONCLUSIONS: Our study demonstrated significant improvement in the early postoperative outcomes by reducing the need for postoperative surgical intervention and polyp formation using steroid-eluting stents when compared with absorbable Nasopore packs. The steroid-eluting sinus stents and the Nasopore packs were each effective in preserving the ethmoid sinus patency and in preventing MT lateralization. A further prospective cohort study with long-term postoperative outcomes is warranted.

Evaluation of the clinical efficacy of nasal surgery in the treatment of obstructive sleep apnoea.

STUDY OBJECTIVES: The aim of the study was to evaluate the clinical efficacy of nasal surgery in the treatment of obstructive sleep apnoea (OSA) by comparing the improvement of subjective symptoms and objective metrics before surgery and after 6 months of surgery. METHODS: Patients with the main complaint of nasal congestion combined with habitual snoring who were hospitalized and treated were selected. Patients underwent subjective symptom tests and objective indicator monitoring both before surgery and 6 months after surgery. Comparisons between groups were performed using the independent samples t-test. RESULTS: Subjective scale evaluations demonstrated that nasal congestion, daytime sleepiness, snoring, nose-related symptoms, and sleep symptoms in patients with simple snoring or with OSA were improved after nasal surgery. Additionally, vitality was improved in all groups except for the patients with simple snoring and emotional consequence was improved in patients with simple snoring and mild OSA. Objective evaluations indicated the apnoea-hypopnoea index (AHI), the thickness of the soft palate, and the maximum cross-sectional area of the sagittal plane of the soft palate decreased after surgery in patients with mild OSA. The lowest blood oxygen concentration (LSaO2) and anteroposterior diameter of the soft palate increased after surgery in patients with mild OSA. The arousal index also significantly decreased in patients with mild and moderate OSA. The nasal cavity volumes (NCVs) and the nasal minimal cross-sectional areas (NMCAs) of all groups showed significant differences after surgery. CONCLUSIONS: Nasal surgery can effectively improve nose and sleep symptoms in patients with simple snoring or with OSA. It can significantly reduce the nasal resistance and increase the ventilation volume. STATEMENT OF SIGNIFICANCE: Obstructive sleep apnoea (OSA) is becoming a global health problem. OSA is associated with several coexisting conditions, reduced health-related quality of life, and impaired work productivity. This study performed nasal surgery on OSA patients with the main complaint of nasal congestion combined with snoring and patients with simple snoring to compare the improvement of subjective symptoms and objective metrics before and after surgery. We found that: (1) symptoms such as nasal congestion, daytime sleepiness or snoring were improved after nasal surgery; (2) the apnoea-hypopnoea index (AHI) and arousal index decreased after surgery in patients with OSA; (3) the nasal and oropharyngeal cavity volumes increased after surgery. These findings suggest that patients with OSA or with simple snoring could benefit from nasal surgery.

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction.

OBJECTIVE: The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. METHODS: Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. RESULTS: By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). CONCLUSION: Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

Identification of hub genes in thyroid carcinoma to predict prognosis by integrated bioinformatics analysis.

The aim of this study was to identify hub genes closely related to the pathogenesis and prognosis of thyroid carcinoma (THCA) by integrated bioinformatics analysis. In this study, through differential gene expression analysis, 1916 and 665 differentially expressed genes (DEGs) were obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) database, and 7 and 11 co-expressed modules were identified from the TCGA-THCA and GSE153659 datasets, respectively, by weighted gene co-expression network analysis. We identified 162 overlapping genes between the DEGs and co-expression module genes as candidate hub genes. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses of the 162 overlapping DEGs identified significant functions and pathways of THCA, such as thyroid hormone generation and metabolic process. A protein-protein interaction (PPI) analysis detected the top 10 hub genes (QSOX1, WFS1, EVA1A, FSTL3, CHRDL1, FABP4, PRDM16, PPARGC1A, PPARG, COL23A1). Finally, survival analysis, clinical correlation analysis, and protein abundance validation confirmed that 3 of the 10 hub genes were associated with survival prognosis of patients with THCA, and 8 of them were associated with the clinical stages of THCA. In summary, we identified hub genes and key modules that were closely related to THCA, and validated these genes by survival analysis, clinical correlation analysis, and Human Protein Atlas image analysis. Our results provide important information that will help to elucidate the pathogenesis of THCA and identify novel candidate prognostic biomarkers and potential therapeutic targets.

Association of chronic rhinosinusitis with bronchial asthma and its severity: A protocol for systematic review and meta-analysis.

BACKGROUND: To explore the association of chronic rhinosinusitis (CRS) with bronchial asthma (BA) as well as its severity. METHODS: A comprehensive database search will be performed from PubMed, Embase, Cochrane Library, and Web of science for related literatures. Heterogeneity test will be used to assess each outcome indicator. If heterogeneity statistics I2 ≥ 50%, the random effects model will be applied; if I2 < 50%, the fixed effects model will be performed. Sensitivity analysis will be performed in all models. STATA 15.0 software (Stata Corporation, College Station, TX) will be used for statistical analysis. Risk ratio (RR) will be used as the effect size for enumeration data. P < .05 is considered statistically significant. CONCLUSION: This study will evaluate the association of CRS with the prevalence of BA as well as its severity. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/GCTM9.

Impact of Varying Types of Nasal Septal Deviation on Nasal Airflow Pattern and Warming Function: A Computational Fluid Dynamics Analysis.

Nasal septal deviations (NSD) have been categorized into 7 types. The effect of these different deviations on airflow pattern and warming function has not been fully investigated. The purpose of this study was to utilize a computational fluid dynamics approach to assess the impact of NSD of varying types on nasal airflow and warming function. Patients with each type of NSD were enrolled in the study, and a normal participant as the control. Using a computational fluid dynamics approach, modeling of nasal function was performed. Indices of nasal function including airflow redistribution, total nasal resistance, airflow velocity, and airflow temperature were determined. Among all types of NSD, the maximal velocity and total nasal resistance were markedly higher in type 4 and 7 deviations. The flow partition and velocity distribution were also altered in type 4 and 7 as well as type 2 and 6 deviations. Airflow in all categories of NSD was fully warmed to a similar degree. From a computational aerodynamics perspective, the type of septal deviation may contribute to altered airflow characteristics. However, warming function was similar between septal deviation types. Future studies will help to ascertain the functional importance of septal deviation types and the applicability of these computational studies.

Multi-Modal Medical Image Fusion Based on FusionNet in YIQ Color Space.

In order to obtain the physiological information and key features of source images to the maximum extent, improve the visual effect and clarity of the fused image, and reduce the computation, a multi-modal medical image fusion framework based on feature reuse is proposed. The framework consists of intuitive fuzzy processing (IFP), capture image details network (CIDN), fusion, and decoding. First, the membership function of the image is redefined to remove redundant features and obtain the image with complete features. Then, inspired by DenseNet, we proposed a new encoder to capture all the medical information features in the source image. In the fusion layer, we calculate the weight of each feature graph in the required fusion coefficient according to the trajectory of the feature graph. Finally, the filtered medical information is spliced and decoded to reproduce the required fusion image. In the encoding and image reconstruction networks, the mixed loss function of cross entropy and structural similarity is adopted to greatly reduce the information loss in image fusion. To assess performance, we conducted three sets of experiments on medical images of different grayscales and colors. Experimental results show that the proposed algorithm has advantages not only in detail and structure recognition but also in visual features and time complexity compared with other algorithms.

Nasal Bone Fractures: Analysis of 1193 Cases with an Emphasis on Coincident Adjacent Fractures.

Importance: The nasal bone is one of the most commonly fractured bones of the midface. However, the frequency of coincident fractures of adjacent bones such as the frontal process of the maxillary bone, nasal septum, and medial or inferior orbital walls has not been fully evaluated. Objective: The purpose of this study was to investigate the incidence of fractures of adjacent structures in the setting of a nasal bone fracture. Second, we propose a new classification system of nasal bone fractures with involvement of adjacent bony structures. Design, Setting, and Participants: One thousand, one hundred ninety-three patients with midfacial fractures were retrospectively reviewed. The characteristics of fractures of the nasal bone and the incidence of coincident fractures of the frontal process of maxilla, bony nasal septum, medial, or inferior orbital walls were analyzed. Exposure: All patients included in the study presented with nasal trauma. Main Outcomes and Measures: The coincident fractures of adjacent midfacial structures were assessed, and a new classification of midfacial fractures based on computed tomography (CT) scan images was proposed. Results: Among the 1193 cases, bilateral fractures of the nasal bone were most common (69.24%), and coexistent fracture of the frontal process of the maxilla and bony nasal septum was 66.89% and 42.25%, respectively. Coincident fracture of the orbital walls was observed in 16.51% of cases. The major etiology of fracture for the younger and elderly groups was falls, compared with assault as the most common etiology in the adult group. A classification scheme was generated in which fractures of the nasal bone were divided into five types depending on coexisting fractures of adjacent structures. Conclusions and Relevance: External force applied to the nasal bone can also lead to coexistent fracture of adjacent bony structures including the frontal process of the maxilla, nasal septum, and orbital walls. The proposed classification of nasal fracture based on CT imaging helps to incorporate coincident disruption of adjacent structures.

Impact of a Concha Bullosa on Nasal Airflow Characteristics in the Setting of Nasal Septal Deviation: A Computational Fluid Dynamics Analysis.

BACKGROUND: A concha bullosa (CB) of the middle turbinate is frequently observed on the nondeviated side of patients with a nasal septal deviation (NSD). However, the impact of the CB on nasal airflow characteristics in patients with NSD has been incompletely defined. OBJECTIVE: The purpose of this study was to evaluate the impact of a CB in patients with NSD on nasal airflow characteristics using a computational fluid dynamics (CFD) approach. METHODS: Twenty patients with NSD and a unilateral CB of the middle turbinate on the nondeviated side (study group) were recruited. Another 20 patients with NSD without the formation of a CB (control group) were also enrolled. Using CFD, the maximal airflow velocity, nasal resistance, maximal wall shear stress, and minimal temperature in the bilateral nostrils of each group were assessed. Moreover, the volume of the nasal tract, surface area-to-volume ratio, and the total nasal resistance were compared between the study and control groups. RESULTS: In the study group, no significant differences of airflow dynamics between the bilateral nasal cavities were observed. In the control group, however, there were statistically significant differences for maximal airflow velocity, nasal resistance, maximal wall shear stress, and minimal airflow temperature between the bilateral nostrils. The surface area-to-volume ratio and total nasal resistance in the study group was significantly higher and the nasal volume was significantly decreased than that in the control group. CONCLUSION: CB of the middle turbinate on the nondeviated side of patients with NSD rendered airflow characteristics more evenly distributed between the bilateral nostrils as assessed by CFD. From an aerodynamics perspective, a CB may represent a compensatory action to normalize airflow dynamics. However, a CB may also result in constriction of the ipsilateral nasal cavity.

Impact of posterior septum resection on nasal airflow pattern and warming function.

Background: The functional significance of the posterior segment of the septum is not fully understood.Aims/Objectives: The purpose of this study was to evaluate the impact of posterior septum resection with varying extents on nasal airflow pattern and warming function, and to determine the appropriate resection extent on posterior septum without disturbing airflow pattern.Material and Methods: Three dimensional models were established from the nasal CT scan of a healthy female volunteer without nasal disease. The models included the normal, as well as 1 cm, 2 cm, and 3 cm extent of posterior septum resection by virtual surgery. Using computational fluid dynamics, the airflow characteristics such as average and peak airflow velocity, average wall shear stress, average temperature and turbulence kinetic energy were recorded and compared among the four models.Results: By comparison with the normal model, the virtual surgeries with varying extents of posterior septum resection (1 cm, 2 cm, and 3 cm), demonstrated little alteration on indices of the average and peak airflow velocity, average wall shear stress, airflow temperature and turbulence kinetic energy. However, a statistical difference of the abovementioned indices existed when compared between varying planes of the nasal cavity (p < .001), although this did not appear to be significantly influenced by the degree of posterior septectomy.Conclusions and significance: From an aerodynamics perspective, little disturbance on airflow pattern and warming function of nasal cavity could be detected with increasing resection of posterior septum (up to 3 cm). These results may imply that resection of the posterior septum (up to 3 cm) has little impact on nasal function.

Apnea-hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea: A meta-analysis.

BACKGROUND: Nasal surgeries have been applied to obstructive sleep apnea (OSA) patients with nasal obstruction for decades. However, the efficiency of nasal surgery in improving OSA remains controversial.The aim of this study was to identify whether isolated nasal surgery can improve apnea-hypopnea index (AHI). METHODS: Computerized searches were performed in MEDLINE, Web of Science, Cochrane Library, and Scopus from January 1, 2000 to April 30, 2016. A total of 18 articles and 587 participants were included. There were 1 randomized controlled trials, 2 nonrandomized trials, 11 prospective studies, and 4 retrospective studies. Data regarding study design (prospective/retrospective clinical trial, randomized, and controlled), population size, participant characteristics (age, gender, and body mass index), surgical intervention, and outcomes (AHI, Epworth sleep scale [ESS]) was collected. RESULTS: Statistically significant improvement in AHI (subgroup 1: weighted mean difference [WMD] [95%confidence interval (CI)], -4.17 [-7.62, -0.73]; subgroup 2: WMD [95%CI], -4.19 [-7.51, -0.88]; overall: WMD [95%CI], -4.15 [-6.48, -1.82]) and ESS (subgroup 1: WMD [95%CI], -2.14 [-3.08, -1.19]; subgroup 2: WMD [95%CI], -4.70 [-5.95, -3.44]; overall: WMD [95%CI], -4.08 [-5.27, -2.88]) was revealed. CONCLUSION: Both AHI and ESS improved significantly after isolated nasal surgery, but the improvement of AHI is slightly significant. Future randomized controlled trials are needed to confirm the long-term benefits of nasal surgery on OSA.

Investigation of resectability degree for adenoidal surgery in OSA children with the method of computational fluid dynamics.

CONCLUSION: From aspect of fluid dynamics, expanding patients' nasopharyngeal coronal-sectional area to 48.3-54.7% of normal area will bring the airflow velocity back to normal in adenoidal hypertrophy children. It might provide a suggestion for adenoidectomy range selection and whether total resection is necessary. OBJECTIVES: To evaluate the nasopharyngeal airflow characteristics in pediatric OSA patients with adenoidal hypertrophy, and to explore the proper resection range for adenoidectomy Method: Nine OSA patients and four normal children were recruited. The CT scans of their upper airway were collected and used to construct three dimensional models for fluid dynamics analysis. Using computational fluid dynamics, indices such as velocity, pressure, and coronal-sectional area were calculated. RESULTS: Compared with the normal, the OSA children showed three characteristics in nasopharyngeal: the airflow velocity was significantly higher (p < 0.05), the coronal-sectional area was significantly smaller (p < 0.01), while pressure showed no difference (p > 0.05). In a study of the relationship between velocity and coronal-sectional area, this study investigates different coronal-sectional areas from 30-300 mm2. It was found that, when patients' nasopharyngeal coronal-sectional area was expanded over 155-170 mm2, namely 48.3-54.7% of normal area, airflow velocity in nasopharyngeal showed no difference than normal.

Computed tomography and histopathological evaluation of osteitis in rabbit models with rhinosinusitis.

CONCLUSIONS: There is clear correspondence between HU and histopathological evaluation of osteitis. It is feasible to evaluate bone remodeling in rabbit models with rhinosinusitis by measuring the HU. OBJECTIVE: The objective of this study was to determine whether the HUs of rabbit CRS models can be used to objectively evaluate the degree of osteitis. METHODS: Sixty rabbit models were inoculated with staphylococcus aureus. The rabbits were divided into three groups. Each group was divided into a medication administration team and a control team. The HU of the bone in each image was measured. All of the animals were executed after the CT exam. The samples for the mucous and bone changes using light microscope observation were scored. These scores and the HU measurements were compared to the actual bone remodeling over time to examine whether we could evaluate bone remodeling by measuring the HU. RESULTS: The average HU scores in Groups A, B, and C were significantly higher than those of normal rabbits (p < .05). The mucous and bone scores increased as the experimental period lengthened (p = .042, 0.002). HU correlated with the mucous and bone scores in rabbit models with rhinosinusitis (coefficient r = .830, 0.641, 0.586, p = .000).

Impact of nasal septal perforations of varying sizes and locations on the warming function of the nasal cavity: A computational fluid-dynamics analysis of 5 cases.

Patients with a nasal septal perforation often exhibit symptoms associated with disturbed airflow, which can have an adverse effect on the warming function of the nasal cavity. The impact of this effect is not fully understood. The warming function is an important factor in the maintenance of nasal physiology. We conducted a study to investigate the impact of septal perforations of various sizes and locations on the warming function during inspiration in 5 patients-3 men and 2 women, aged 25 to 47 years. Three-dimensional computed tomography and computational fluid dynamics were used to model the flux of communication and temperature, and differences among patients were compared. All 5 patients exhibited an impairment of their nasal warming function. As the size of the perforation increased, the flux of communication increased and the warming function decreased. Perforations located in an anterior position were associated with greater damage to the warming function than those in a posterior position. In patients with a large or anteriorly located perforation, airflow temperature in the nasopharynx was decreased. Our findings suggest that septal perforations not only induce airflow disturbance, but they also impair the nasal warming function. Further analysis of warming function is necessary to better explore flow mechanisms in patients with structural abnormalities.

The effectiveness of nasal surgery on psychological symptoms in patients with obstructive sleep apnea and nasal obstruction.

Conclusion Nasal obstruction can aggravate the psychological status of OSA patients, and nasal surgery should reduce this aggravation. Nasal surgery significantly improved sleep latency and ameliorated several polysomnographic characteristics. Background The aim of this study was to investigate the psychological status of patients with obstructive sleep apnea (OSA) and nasal obstruction and to evaluate the effects of nasal surgery on the psychological symptoms and polysomnographic (PSG) parameters of these patients. Methods The study was designed as a prospective comparative study. This study compared 30 patients (all male) with nasal obstruction and 30 matched patients without nasal obstruction using the Pittsburgh Sleep Quality Index (PSQI) and the Symptom Check List 90 (SCL-90). All of the patients had been previously diagnosed with OSA (apnea hypopnea index [AHI] ≥ 5 events/h) via a whole-night polysomnographic examination. Nasal obstruction was assessed using a visual analogue scale (VAS). The patients with nasal obstruction underwent nasal surgery, and their weight, VAS, nocturnal PSG characteristics, and psychological symptoms at baseline and 3 months after surgery were compared. Results The OSA patients with nasal obstruction suffered from significantly longer sleep latency on the PSQI and higher somatization and anxiety scores on the SCL-90 than the subjects without nasal obstruction (p < 0.05). The nasal obstruction symptoms significantly improved after surgery (VAS decreased from 6.18 ± 1.85 to 1.87 ± 1.76, p < 0.01). The assessments also showed a significant reduction in weight (from 84.60 ± 11.30 kg to 82.27 ± 9.87 kg, p < 0.05) between the pre-operative and post-operative values. Although there was significant reduction in the AHI (from 49.67 ± 19.49/h to 43.07 ± 21.86/h, p < 0.01) and a significant improvement in lowest oxygen saturation (LSpO2, from 73.83 ± 8.49% to 75.97 ± 9.86%, p < 0.05), only 23.3% of patients achieved a response of nasal surgery that met Sher's criteria. Remarkable reductions were observed in the sleep latency scores, daytime dysfunction scores on the PSQI, anxiety and hostility scores, and the number of positive symptoms on the SCL-90 (p < 0.05). There was a strong positive correlation between PSQI total score and some psychosomatic symptoms on the SCL-90, including inter-personal sensitivity, depression, hostility, paranoid ideation, psychoticism, global symptom index, and the number of positive symptoms (r > 0.3, p < 0.05).

[Study on the correlation between the ostia diameter changes and airflow characteristics in maxillary sinus].

OBJECTIVE: To investigate the relationship between the maxillary sinus flow field, temperature field and the maxillary sinus ostium size, and to provide a reference for endoscopic surgery according to the maxillary sinus scope. METHODS: One case of adult female CT image data was obtained, and used to build a three-dimensional model of nasal cavity and maxillary sinus. Computational fluid dynamics method was used to study the airflow and temperature of the maxillary sinus, as well as the physiological function of the maxillary sinus. Simulation surgery by means of different maxillary sinus diameters (normal, 8 mm, 10 mm, 12 mm and 15 mm) was used to describe the maxillary sinus airflow and temperature change. RESULTS: It was found that by numerical simulation the airflow of maxillary sinus and nasal cavity showed lower speed (average speed 0.062 m/s) than that in the middle nasal meatus (average speed of 3.260 m/s), and the average temperature in the normal maxillary sinus was 34°C, which was higher than that in the middle nasal meatus (temperature 28.7°C). With the increase of the diameter of the maxillary sinus, the air temperature change was not obvious. CONCLUSIONS: The physiological function of the maxillary sinus can be studied through the numerical simulation. With the increase of the ostia diameter of maxillary sinus, the sinus temperature and ventilation is not affected. It provides a reference for quantification of clinical endoscopic maxillary sinus surgery.