Presence of Tertiary Lymphoid Organ in Nasal Inverted Papilloma Is Correlated with Eosinophil Infiltration and Local Immunoglobulin Production.

INTRODUCTION: Nasal inverted papilloma (NIP) is a benign tumour with multiple inflammatory cell infiltration. Tertiary lymphoid organs (TLOs) support local antibody production and play important roles in airway inflammation. However, the evidence of TLOs and local immunoglobulins in NIP has not been reported yet. We investigated the presence of TLOs and immunoglobulins in NIP tissues and their association with the clinical-pathological characteristics of NIPs. METHODS: We analyzed the occurrence and composition of TLOs and local immunoglobulins by immunohistochemistry and evaluated the lymph organogenesis associated genes and cytokines by quantitative qPCR and Luminex assays, respectively, in papilloma tissues from 84 NIP cases. RESULTS: TLOs were present in 54% (45/84) of the NIP patients but not in control subjects. TLOs were composed of T cells, B cells, follicular dendritic cells, macrophages, and natural killer cells. Compared to NIP tissues without TLOs, tissues with TLOs showed significantly higher eosinophil infiltration levels (3.5-fold), elevation of lymphorganogenic genes (CXCL12, CXCL13, CCL20, CCL21, CD21L, and lymphotoxin alpha and beta), and increased Th17 (IL-21, IL-22, and GM-CSF) and Th2 (IL-5 and IL-13) cytokine production. Moreover, NIP with TLOs demonstrated a higher number of follicular T helper cells and immunoglobulin-producing plasma cells (CD138+ IgA+, CD138+ IgM+, CD138+ IgE+, and CD138+ IgG+) than those without TLOs, and these antibody-producing cells were positively correlated with the eosinophil number. CONCLUSION: The high frequency of TLOs and excess local immunoglobulin production are associated with an eosinophilic and Th2 skew microenvironment in the NIP mucosa, which would contribute to an important immunopathogenic response during NIP pathogenesis.

Downregulation of MCM2 contributes to the reduced growth potential of epithelial progenitor cells in chronic nasal inflammation.

BACKGROUND: Recent studies have shown that human nasal epithelial progenitor cells (hNEPCs) are characterized by poor proliferation capacities during chronic nasal inflammation. OBJECTIVE: We sought to investigate the key molecular functions and candidates that contribute to the reduced growth potential of hNEPCs in chronically inflamed nasal mucosa. METHODS: Nasal biopsy specimens were obtained from 28 patients with nasal polyps (NPs) and 13 healthy controls. hNEPCs from nasal samples were cultured for 3 consecutive passages, and their molecular and functional profiles were analyzed by RNA sequencing. The minichromosome maintenance protein (MCM) family gene MCM2 was validated in hNEPCs and tissue samples from patients with NPs and control subjects by cell cycle, quantitative PCR, and Western blot analyses; small interfering RNA-mediated knockdown assay; and immunofluorescent staining. RESULTS: Compared with control hNEPCs, NP-derived hNEPCs showed (1) reduced growth kinetics, as evidenced by the colony-forming efficiency and doubling time; (2) inhibited cell cycle progression, as evidenced by gene ontology and/or pathway and cell cycle analyses; and (3) downregulated expression of MCM2, the key protein of the MCM complex, which is critical for DNA replication at the G1/S checkpoint. Moreover, hNEPCs with MCM2 knockdown showed a decreased proliferation rate, and the MCM2 protein level in basal cells was significantly lower in abnormally remodeled nasal epithelium than in normal epithelium. CONCLUSION: These results demonstrate inhibited cell cycle progression and MCM2 downregulation in basal or progenitor nasal epithelial cells from NP tissue, which may contribute to the decreased growth potential of hNEPCs in chronically inflamed upper airways.

Increase in IL-17-positive cells in sinonasal inverted papilloma.

OBJECTIVE: Neutrophil infiltration in patients with sinonasal inverted papilloma (SNIP) is significantly high. Whether IL-17, which is a potent factor mediating neutrophilic inflammation, is involved in the neutrophilic phenotype of SNIP is investigated in the current study. STUDY DESIGN: Laboratorial study. PARTICIPANTS: Nasal papilloma and inferior turbinate were collected from patients with SNIP (n = 50) and control subjects with septal deviation (n = 15). METHODS: IL-17 + cells were evaluated in tissues obtained from patients with SNIP and control subjects with septal deviation, by immunohistochemistry and flow cytometry. MAIN OUTCOME MEASURES: The IL-17 + cells were mainly localised in mononuclear cells and neutrophils, and were up-regulated in the SNIP samples compared with those in the controls. The IL-17 + T-cell subsets mainly included CD4+ (Th17, 60.0%) and CD8+ (Tc17, 30.0%), and both subsets were enhanced in the SNIP samples than controls. The total level of IL-17 + cells was significantly correlated with neutrophil infiltration in the SNIP tissues. Furthermore, the SNIP homogenates could significantly promote IL-17 production in peripheral blood mononuclear cells. CONCLUSIONS: An increase in IL-17 + cells is evident in SNIP and may be involved in neutrophil infiltration in local tissues. IL-17 could be a potential therapeutic target to relieve the neutrophilic pathological change in SNIP.

NOD-like receptor family, pyrin domain containing 3 (NLRP3) contributes to inflammation, pyroptosis, and mucin production in human airway epithelium on rhinovirus infection.

BACKGROUND: The airway epithelium maintains mucosal homeostasis and effectively responds to pathogens. The roles of the epithelial NOD-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome in human rhinovirus (hRV) infection and its effects mediating epithelial functional changes remain poorly understood. OBJECTIVE: We investigated the mechanisms and cellular functions mediated by the epithelial NLRP3 inflammasome on hRV infection. METHODS: Using models of primary human nasal epithelial progenitor cells and differentiated human nasal epithelial cells (hNECs) infected by hRV, we functionally examined key factors for NLRP3 inflammasome activation, cell death, and mucus production. Furthermore, NLRP3 and IL-1ß in human epithelium from nasal mucosal inflammation induced by hRV were evaluated. RESULTS: The inflammasome-mediated IL-1ß secretion and pyroptosis in human nasal epithelial progenitor cells and hNECs on hRV infection were dependent on the DDX33/DDX58-NLRP3-caspase-1-GSDMD axis. In differentiated hNECs hRV could also promote major airway epithelial mucin (MUC5AC) production through this axis. Our results further confirmed that the NLRP3 inflammasome signaling pathway was responsible for suppressing hRV replication in airway epithelium. Finally, hRV infection in chronically inflamed nasal mucosa was associated with epithelial mucus hyperproduction, whereas NLRP3 and IL-1ß expression levels were significantly increased in hRV-infected epithelium with goblet cell hyperplasia compared with normal epithelium without viral infection. CONCLUSION: The current study showed that the NLRP3 inflammasome signaling axis could functionally mediate hRV-induced inflammation, pyroptosis, and mucus production in airway epithelium, which might be an essential mechanism associated with hRV-induced airway remodeling.

MicroRNA-21 Mediates the Protective Effects of Mesenchymal Stem Cells Derived from iPSCs to Human Bronchial Epithelial Cell Injury Under Hypoxia.

Airway epithelial cell injury is a key triggering event to activate allergic airway inflammation, such as asthma. We previously reported that administration of mesenchymal stem cells (MSCs) significantly alleviated allergic inflammation in a mouse model of asthma, and the mmu-miR-21/ACVR2A axis may be involved. However, whether MSCs protect against bronchial epithelial cell injury induced by hypoxia, and the underlying mechanism, remain unknown. In our study, the human bronchial epithelial cell line BEAS-2B was induced to undergo apoptosis with a hypoxia mimic of cobalt chloride (CoCl2) damage. Treatment of MSCs derived from induced pluripotent stem cells (iPSCs) significantly decreased apoptosis of BEAS-2B cells. There was high miR-21 expression in injured BEAS-2B cells after MSC treatment. Transfection of the miR-21 mimic significantly decreased apoptosis of BEAS-2B, and transfection of a miR-21 inhibitor significantly increased apoptosis. More importantly, the protective effects of MSCs on injured BEAS-2B were reversed by transfection of the miR-21 inhibitor. Binding sites of human miR-21 were identified in the 3'UTR of human ACVR2A. We further determined that CoCl2 stimulation increased ACVR2A expression at both the mRNA and protein levels. Moreover, transfection of the miR-21 mimic further up-regulated ACVR2A expression induced by CoCl2, whereas transfection of the miR-21 inhibitor down-regulated ACVR2A expression. In addition, MSCs increased ACVR2A expression in BEAS-2B cells; however, this effect was reversed after transfection of the miR-21 inhibitor. Our data suggested that MSCs protect bronchial epithelial cells from hypoxic injury via miR-21, which may represent an important target. These findings suggest the potentially wide application of MSCs for epithelial cell injury during hypoxia.

Expression of Nogo receptor 1 in the regeneration process of the mouse olfactory epithelium.

Nogo receptor 1 (NgR1) is the most important Nogo-A receptor. By its interaction with myelin-associated inhibitory proteins, NgR1 inhibits the regeneration of axons and is extensively expressed in the central nervous system. However, the expression of NgR1 in regenerable neurons, such as olfactory neurons, and its expression in the regeneration progress of olfactory neurons have not been reported. In this study, we demonstrated that NgR1 was expressed in the cell bodies of certain mature olfactory receptor neurons (ORNs) but was not expressed in immature ORNs in the olfactory epithelium (OE) of normal adult mice. On day 21 after OE injury, NgR1 was expressed not only in the cell bodies of mature ORNs but also in the cell bodies of glial fibrillary acidic protein (GFAP)-positive cells in the top and submucosal layers of the OE. On day 48 after model establishment, NgR1 expression decreased in the cell bodies of the GFAP-positive cells. On day 56 after model establishment, no NgR1 expression was found in the cell bodies of the GFAP-positive cells, and NgR1 was again expressed only in the mature ORNs. Our results demonstrated that NgR1 expression is upregulated in the OE after injury, which suggests that NgR1 might be involved in the regeneration of the OE.

Bioinformatic analysis of c-Myc target from laryngeal cancer cell gene of laryngeal cancer.

AIM OF STUDY: The aim was to explore the structure and functions of new target spot c-Myc target from laryngeal cancer cell. (MTLC) of c-Myc gene. METHODS: This study adopted bioinformatic methods to analyze the physicochemical property, secondary structure, hydrophobic region, a transmembrane region, and prediction of functions. RESULTS: The results showed that the whole length of the open reading frames was 708 bp, coding was 235 amino acids. This protein was a basic protein possessed two transmembrane structures and weight was about 26592.5 Da. The main elements of secondary structure were alpha-helix and random coil. MTLC was a membrane constitutive protein that possessed signal transduction and regulation may locate on karyotheca as results of subcellular localization and function prediction. CONCLUSION: This study has provided the theoretical basis for the further discussion of the effect and mechanism of action of MTLC in the occurrence of laryngeal cancer.

Endoscopic nasopharyngectomy for salvage in nasopharyngeal carcinoma: a novel anatomic orientation.

OBJECTIVES/HYPOTHESIS: Nasopharyngectomy for residual/recurrent nasopharyngeal carcinoma (NPC) using an endoscopic technique is less invasive than traditional methods. Our objective was to identify the important anatomic landmarks so that the endoscopic surgeon can avoid injury to the internal carotid artery and perform a nasopharyngectomy safely. STUDY DESIGN: Anatomical study. METHODS: Transnasal endoscopic dissection was carried out on three fresh adult cadaver specimens (six sides) after arterial latex injection. Measurements were made in 50 adult skulls (100 sides), detailing the distances between orienting critical landmarks and the internal carotid canal (external aperture). RESULTS: Adequate exposure for endoscopic nasopharyngectomy is available by removing portions of the inferior turbinate, nasal septum, and medial pterygoid plate. Anatomy of the operative field (endoscopic view) is described. Orientating topical landmarks include: posterior portions of the inferior turbinate and nasal septum, fossa of Rosenmuller, and the torus tubarius. The deep landmarks include: medial pterygoid plate-posterior margin at the skull base, eustachian tube isthmus, foramen lacerum, and the longus capitis. All topical and deep landmarks were identified from the endoscopic point of view and their distances to the internal carotid canal (external aperture) were measured. CONCLUSIONS: This anatomic study provides novel orienting landmarks for endoscopic nasopharyngectomy. Surgeons can efficiently and safely deal with residual and/or recurrent NPC endoscopically.

[Transnasal endoscopic optic nerve decompression for traumatic optic neuropathy: analysis of 155 cases].

OBJECTIVE: To explore the outcome of transnasal endoscopic optic nerve decompression (TEOND) for traumatic optic neuropathy (TON). METHODS: The clinical data of 155 consecutive patients with TON treated with TEOND after failure of mega-dose steroid therapy were retrospectively analyzed, their outcomes were summarized after follow-up, and then Logistic regression was used to analyze the prognosis-related information to explore the factors influencing prognosis. RESULTS: Patients were followed up for 3 - 60 months. The total effective rate of the 155 patients was 44.5%. The effective rate of the patients with light perception or better vision was 87.5%, much higher than that of the patients without light perception (29.6%). Eyesight was improved, mostly occurring 1 - 5 days after operation and lasting for 1 - 3 months, in 69 patients. Residual vision degree after trauma (OR = 0.04) and the interval between injury and surgery (OR = 4.62) were significant prognostic factors of the general effect (P < 0.01), and the gradual or immediate visual loss history (OR = 0.22) and the interval between injury and surgery (OR = 6.34) were significant to the outcomes of the patients with no light perception (P < 0.05). Sex, age, duration of coma after trauma, pre- and post-operative duration of steroid treatment, operators, fracture site of optic canal, and nerve sheath incision were not correlated to the outcomes of patients (all P > 0.05). Intraoperative cerebrospinal fluid rhinorrhea and postoperative transient visual loss occurred in one and the other two cases, respectively, but these conditions were resolved successfully. CONCLUSION: TEOND is effective and safe for TON patients, but the visual outcome is poor for the immediate blindness cases. The surgery is indicated for the patients with some residual vision or with a gradual visual loss and is suggested to perform early within seven days after injury.

[Timing of operation and therapeutic effect of endoscopic optic nerve decompression for traumatic optic neuropathy].

OBJECTIVE: To observe the optimal timing of operation and the therapeutic effect of endoscopic optic nerve decompression for traumatic optic neuropathy (TON). METHODS: The clinical records of 90 consecutive patients with TON (93 eyes) after head and/or maxillofacial trauma from April 1998 to March 2007 were reviewed and analyzed. All patients were either unresponsive or intolerant to medication before they underwent intranasal endoscopic optic nerve decompression. The time interval between the injury and operation ranged from one day to 97 days (median 5.5 days). Among the 93 eyes, there were 71 eyes with no visual acuity before operation and 22 eyes with residue visual acuity, including light perception in 1 eye, hand movement in 5 eyes, counting fingers in 13 eyes, 0.04 in 1 eye, and 0.1 in 2 eyes. Duration of follow-up ranged from 6 days to two years (median 8 days). RESULTS: After decompression, 35 patients (36/93 eyes, 38.7%) showed improvement of visual acuity, 53 patients (55 eyes, 59.1%) remained the same as before operation, while 2 patients (2 eyes, 2.2%) showed decreased visual acuity. Among patients with visual acuity beyond light perception before decompression, 68.2% of them (15/22 eyes) experienced visual improvement, whereas only 22.9% (8/35 eyes, 0.02 in two eyes) among patients who lost visual acuity immediately after injury, and 36.1% (13/36 eyes, 0.02 in five eyes) among those who lost visual acuity gradually after injury. There was a significant difference in visual improvement between group with visual acuity and group with no visual acuity (chi(2) = 11.864, P < 0.01). Among patients with no visual acuity, 41.2% of those (7/17 eyes) who underwent operation within 3 days of injury, experienced improvement in visual acuity, compared with 25.9% (14/54 eyes) for those who underwent the operation more than 3 days after injury. It was indicated that no significant difference in visual improvement between these two groups (chi(2) = 1.46, P > 0.05). When comparing different sites of fracture, the effect of surgery was the most desirable (55.6%, 10/18 eyes improved) if the fracture occurred simultaneously in both exterior and interior walls of optic canal, followed by the interior wall fracture (45.7%, 21/46 eyes). The operation was less effective if there was no fraction (20%, 4/20 eyes) or if the fracture occurred in exterior wall alone (11.1%, 1/9 eyes). CONCLUSIONS: Endoscopic optic nerve decompression is a minimally invasive procedure with no adverse cosmetic effects. Early operation is recommended for saving vision, even though visual acuity is lost immediately after injury. However, the satisfactory clinical effects of endoscopic optic nerve decompression require further study.

[Quality of life outcome of patients with chronic rhinosinusitis and nasal polyposis after endoscopic sinus surgery and its influencing factors].

OBJECTIVE: To explore the quality of life (QOL) outcome of patients with chronic rhinosinusitis (CRS) after endoscopic sinus surgery (ESS) and its influencing factors. METHODS: prospective trial was conducted to survey the QOL status of 120 CRS patients undergoing ESS, in contrast that of 200 healthy individuals passing health examination, at the baseline and at 12-months after operation by Medical Outcomes Study Short Form-36 (SF-36) and Sino-Nasal Outcome Test-20 (SNOT-20). QOL changes and its influencing factors were analyzed statistically. RESULTS: (1) By the assessment of SF-36, the scores of 6 domains were less than that of healthy individuals preoperatively (P < 0.01). After 6 months, the scores of these domains resumed normal level and the proportion of scores also restored normally (P > 0.05). (2) By the assessment of SNOT-20, the total scores of 20 items and 5 most important items of patients were more than that of healthy objects (P < 0.01). After 9 and 12 months, the former and latter returned to normal, respectively (P > 0.05). In 12 months setting, the proportion of scores also restored normally (P > 0.05). (3) According to the survey of SNOT-20, we concluded the following equation: convalescent time (months) = 39--(normal scores/preoperative scores) x 50, by which the time of coming back to normal QOL status can be computed. (4) By analysis of Logistic Regression, residence in city or country, course of disease, extension of diseased sinus, and coexistence of nasal polyposis or not were correlated to the preoperative QOL scores; working environments, surgical extension, and preoperative scores of QOL were correlated to the score difference between pre and post operation. CONCLUSIONS: CRS patients undergoing ESS could obtain entirely normal QOL status at 12 months postoperatively, so we suggest that the essential follow-up period should last at least one year. The risk factors influencing patients QOL status preoperatively includes residence in country, longer course of disease, more extension of diseased sinus, and coexistence of nasal polyposis. The risk factors hindering the improvement of QOL status postoperatively includes exposure to indoor working environments, insufficient surgical extension, and lower preoperative QOL scores.

[Subjective and objective clinical outcome assessment on chronic rhinosinusitis following endoscopic sinus surgery].

OBJECTIVE: To assess the subjective and objective outcomes of chronic rhinosinusitis (CRS) following endoscopic sinus surgery (ESS) and establish an assessment system of outcome with ease of application clinically. METHODS: A prospective cohort study was conducted to survey and assess the outcomes of 120 consecutive CRS patients undergoing endoscopic sinus surgery at 12 months after operation. The subjective and objective measures comprised symptom by visual analog scale (VAS), health-related quality of life by medical outcome study short-form 36-items (SF-36) and sino-nasal outcome test-20 (SNOT-20) scales, endoscopic appearance, mucociliary function, and histological findings. The differences of subjective and objective assessments before and after operation were compared by t-test and Chi-Square test and the correlations between the parameters above were analyzed by Spearman correlation analysis. RESULTS: At 12 months after operation, the patients' total scores by VAS, SF-36 and SNOT-20 scales improved significantly beyond the preoperative survey (P < 0.01); there were 85.96%, 77.19% and 83.33% patients with the scores respectively superior to that of preoperation, of which 72.28% subjects benefited simultaneously from these parameters; and a significant correlation was observed among them before and after operation (P < 0.01) where SNOT-20 showed a more compatibility than the other two. At 12 months after operation, the patients' total scores of endoscopic appearance, mucociliary function, and histological findings significantly improved beyond the preoperative evaluation (P < 0.05); there were 86.84% , 86.81% and 75.57% patients with the scores respectively superior to that of preoperation, of which 71.85% subjects benefited simultaneously from these parameters; and a significant correlation was observed among them before and after operation (P < 0.05) where endoscopic appearance showed a more compatibility than the other two. At 12 months after operation, 74.56% patients showed an accordant improving or worsening outcome evaluated by SNOT-20 and endoscopic appearance, while 25.44% ones represented inverse endings, of which patients with comorbidity of nasal polyps more easily demonstrated this tendency significantly (P < 0.05). No significant correlation existed between the scores of SNOT-20 and endoscopic appearances both in preoperation and in postoperation (P > 0.05), but the total scores of the anterior 10-item, excluding the posterior 10-item, of SNOT-20 inventory was found significantly correlated with the quantitative appearances on nasal endoscopy throughout (0.18 < or = 0.42, P < 0.05). CONCLUSIONS: Administration of ESS can effectively improve the outcomes of CRS patients including symptom, health-related quality of life, endoscopic appearance, mucociliary function, and histological findings. A subjectively and objectively measured assessment system with tenseness, trustiness, reasonableness, and effectiveness and with ease of application clinically is established on the basis of SNOT-20 and endoscopic appearance evaluation for outcome research.

[Postoperative symptoms and life quality assessment of chronic rhinosinusitis patients received endoscopic sinus surgery].

OBJECTIVE: To implore the positive effects of endoscopic sinus surgery on the symptoms and quality of life (QOL) of patients with chronic rhinosinusitis (CRS) and their changing regularity of symptoms and QOL. METHODS: A prospective, randomized and controlled trial was conducted to survey symptoms and QOL status of 120 CRS patients undergoing endoscopic sinus surgery, in contrast to that of 200 healthy individuals passing health examination, at the baseline and at 3- and 6-months postoperatively by visual analog score (VAS) symptom instrument and QOL instruments including medical outcome study short-form 36-items health survey (SF-36) and sino-nasal outcome test-20 (SNOT-20). RESULTS: In the 3 months follow-up settings, total of individual symptom severity scores and global symptom severity scores of VAS, such domains as role physical and general health of SF-36 and total of the 20 items scores and the most important 5-item scores of SNOT-20 all began to get better markedly (P < 0.05); in the 3-6 months follow-up settings, the indices above stayed fixed (P > 0.05); and in the 6-months follow-up settings, indices of symptoms and QOL status entirely improved from the baseline, with SF-36 showing no scoring difference between CRS patients and healthy individuals, whereas VAS showed that abnormal nasal drainage and decreased sense of smell were still left and SNOT-20 showed that abnormal nasal drainage and lack of good sleep left, inferior to that of healthy objects significantly (P < 0.05). CONCLUSIONS: On the whole CRS patients undergoing endoscopic sinus surgery recover symptomatically and come back to normal level of QOL status at the 6 months postoperatively, but such significant problems as abnormal nasal drainage, decreased sense of smell and lack of good sleep still remain and need to be treated.

[Relationship between transcription factor GATA-3 and cytokines expression in chronic sinusitis].

OBJECTIVE: To explore the correlation between the expression of GATA-3 and the level of local cytokines (IL-5, IL-6 and IL-8). METHODS: The levels of IL-5, IL-6 and IL-8 in ethmoid sinus mucosa were titrated in 45 patients with chronic rhinosinusitis and 11 normal subjects by ELISA. Patients were divided into AR group (with allergic rhinitis) and NAR group (without allergic rhinitis) . Semi-quantitative RT-PCR and immunohistochemical staining were used to examine the GATA-3 expression in nasal mucosa. The correlation between the expression of GATA-3 and the levels of cytokines was evaluated. RESULTS: IL-5, IL-6 and IL-8 levels in both AR and NAR groups were significantly elevated compared with normal group (all P < 0.01 for AR group; P < 0.05, 0.05, 0.01 for NAR group, respectively), and they were much higher in AR group in comparison with NAR group (P < 0.01, 0.05, 0.01, respectively). Semi-quantitative RT-PCR showed that AR and NAR groups had markedly greater level of GATA-3 mRNA than that in control group (P < 0.01, respectively), and the level of GATA-3 mRNA in AR group was further higher than that in NAR group (P < 0.01). Immunohistochemical staining illustrated that GATA-3 was primarily presented in cytoplasma and the GATA-3 positive cells were mainly infiltrating inflammatory cells in submucosa. The mean GATA-3 positive-staining rate was (27. 90 +/- 16.75)% and (10.22 +/- 0.05)% in AR and NAR group, which were markedly higher than (1.30 +/- 1.78)% in control group (P < 0.01, respectively). Pearson correlation analysis demonstrated that GATA-3 positive-staining rate was closely correlated with IL-5 level, but not IL-6 and IL-8. The correlation coefficient was 0. 712 for GATA-3 and IL-5 (P < 0.01), 0.200 for GATA-3 and IL-6 (P > 0.05), 0.089 for GATA-3 and IL-8 (P > 0.05). CONCLUSIONS: Activation of GATA-3 might be one of the mechanisms for induction of IL-5 expression in chronic rhinosinusitis . Concomitance of allergic rhinitis with chronic rhinosinusitis further increased expression of GATA-3, and subsequently enhanced IL-5 expression. Chronic sinusitis may be related to allergy, and GATA-3 may play a key role in the pathogenesis of chronic sinusitis.

[Endoscopic evaluation of mucous membrane inflammation in chronic rhinosinusitis and analysis of correlated factors].

OBJECTIVE: The purpose of this article is to establish an endoscopic score system for quantitative evaluation of the inflammation of mucous membrane in patients with chronic rhinosinusitis (CRS) , and to investigate the correlation of this system with a variety of clinical factors. METHODS: A set of score system was constructed based on anatomic configuration, status of mucous membrane and nasal secretion to evaluate quantificationally the severity of inflammation of CRS. The clinical correlation of this system was studied prospectively in 60 CRS patients, with a variety of clinical factors which included age, duration of disease, previous recurrence and the years from recent recurrence, atopy, serum total immunoglobulin E (TIgE), serum eosinophil cationic protein (ECP), the count of blood eosinophil, the count of tissue inflammatory cell, the extension of CRS indicated by CT, smoking, concomitant chronic inflammation in lower respiratory tract. All above factors were analyzed statistically with the endoscopic score by Pearson correlation and multi-factor linear regression analysis. RESULTS: In pearson analysis, the correlative factors with the evaluated score included age (x1, r = - 0.310, P = 0.016), the extension of disease (x2, r = 0. 810, P < 0.0005), recurrence (x3, r = 0.408, P = 0.001), eosinophil of nasal tissue (x4, r = 0.279, P = 0. 031), duration of disease (x5, r = 0.536, P < 0.0005), concurrent nasal polyps (r = 0.549, P < 0.0005), plasm cell (r = 0. 317, P = 0.014) and years from the recent recurrence (r = 0.385, P = 0.002). In multi-factor linear regression, the five independent predictive factors were recurrence, age, extension of disease, tissue eosinophils, years of disease. The regressive equation is y = 10.148 - 0.152 (x1) + 2.250 (x2) + 3.348 (x3) + 1.233 (x4) + 0.270 (x5). CONCLUSIONS: Appropriate score system by nasal endoscopy is feasible to evaluate quantificationally the degree of inflammation of CRS; being appropriately modified, it is even able to reveal the underlying histological behavior finely.

[Computer-assisted anatomical study of nasofrontal region].

OBJECTIVE: To evaluate the value of Advantage Windows 3.1 (AW 3.1) software for anatomical study of nasofrontal region, and to study the CT characteristics of nasofrontal region which related to the frontal sinus surgery. METHODS: Eighty patients underwent axial consecutive computed tomography scans and these data were studied with AW 3.1 software which provided reconstructional imaging of continuous coronal, sagittal, axial sections. Some related structures of nasofrontal region were studied and measured. RESULTS: AW 3.1 software could identify and measure the following structures accurately: The diameter of frontal sinus was (22.5 +/- 8.6) mm in height, (16.3 +/- 6.8) mm in depth, (23.8 +/- 9.8) mm in breadth. The diameter of frontal sinus ostium: the anterior-posterior diameter was (7.3 +/- 1.7) mm, the transverse diameter was (8.5 +/- 1.9) mm. The width of nasal beak of frontal bone(5.9 +/- 1.4 ) mm. The distance of frontal sinus ostium to the floor of columella nasi and the corresponding angle to the nasal floor were (60.8 +/- 4.2) mm and (70.1 +/- 4.7) degrees. The superior attachment sites of the uncinate process were as follows: lamina papyracea 41%, posteromedial wall of agger nasi cell 11%, middle turbinate 19%, anterior skull base 16%, superior bifurcation 13%. The cells could impinge on the frontal recess to cause obstruction (terminal recess 38.8%, anterior ethmoid cell 27.6%, agger nasi cells 24.5%). The accessory cells could impinge on the frontal sinus (perifrontal cells 32.7%, superaorbital cells 38.8%, intersinus septal cells 32.0%). There was significant difference between two groups of characteristics of nasofrontal region. CONCLUSIONS: AW 3.1 software is a helpful and powerful new tool for anatomical study of nasofrontal region and for preoperative evaluation. The structures of nasofrontal region are complex and various, frontal sinusitis almost always results from the obstruction of frontal sinus outflow tract. These results of anatomical study of nasofrontal region are helpful in directing the functional endoscopic surgery in frontal sinus.

[Transnasal endoscopic frontal surgery for chronic frontal sinusitis].

OBJECTIVE: The recurrence of chronic frontal sinusitis after endoscopic surgery is mainly due to the mismanagement of frontal recess and frontal sinus orifice. The aim of this study is to investigate the characteristics of chronic frontal sinusitis and to advance the clinical therapeutic efficacy. METHODS: Different methods were used to manage different local diseases in frontal sinus orifice or frontal recess in 58 cases (96 sides) with chronic frontal sinusitis by nasal endoscopic surgery. RESULTS: Different degree of middle meatal obstruction was seen in all cases at operation. The situation of frontal sinus ostium and frontal recess was as follows: 38 sides obstructed by swollen mucosa, polypoid mucosa or polyps, no cell obstruction at frontal sinus orifice; 34 cases constricted by over development of agger nasi cells, ethmoid bulla or terminal cell at frontal recess; 15 cases obstructed completely by over development cells at frontal recess; osteal stenosis at frontal sinus orifice in 9 cases. The situation in frontal sinus was as follows: pus accumulation in 18 sides, mucosal swollen in 21 sides, mucosal congestion in 49 sides, no obvious mucosal diseases in 8 cases. Follow-up for 6-20 months showed that 69 sides (71.9%) were cured, 17 sides (17.7%) better and 10 cases (10.4%) recurrent. CONCLUSION: Obstruction of osteomeatal complex and frontal recess is the main causes of chronic sinusitis. There are four pathologic states in obstruction of frontal recess and frontal ostium. Different operative methods should be taken according to different pathological changes. The operative effects is still needed to improve.

[Clinical evaluation of local application of Merogel after endoscopic sinus surgery].

OBJECTIVE: To study the auxo-action of Merogel (hyaluronic acid) for operative cavity epithelialization after endoscopic sinus surgery (ESS). METHOD: Sixteen patients (32 sides) were observed, in which all sinuses(maxillary, frontal, ethmoid and sphenoid) were operated on by ESS. For the purpose of control study, the left nasal side was used as Merogel group, and right side contrast group. The patients were followed-up for 12 weeks. RESULTS: In Merogel group, the curative rate was 93.75%, improvement rate 6.25%, and average time of epithelialization was 3.4 weeks. In contrast group, the curative rate was 87.50%, improvement rate 12.50%, and average time of epithelialization was 8.3 weeks. It was distinct that in Merogel group, the epithelialization time was shorter than that in contrast group. CONCLUSION: Merogel has auxo-action for operative cavity epithelialization after ESS.

[Treatment of endonasal-encephalomeningocele by transnasal endoscopic surgery].

OBJECTIVE: To inquire into the feasibility of transnasal endoscopic surgery for endonasal encephalomeningocele, and to put forward the basic management guidelines. METHOD: Five cases of endonasal encephalomeningocele were managed by transnasal endoscopic surgery. Different surgical techniques were applied according to the size and shape of skull base defect. At the same time, one-stage repair of skull base defect was achieved by applying muscle, fascia, cartilage and bone. RESULTS: All 5 patients were successfully treated without complication and relapse during 1-5 year follow-up. CONCLUSION: Endonasal type encephalomeningocele can be managed by transnasal endoscopic surgery. If the skull base defect is less than 0.5 cm, it can be repaired by packing muscle and fascia. If the defect is larger than 0.5 cm, the cartilage or bone should be used to repair the skull base.