Clinical and psychobehavioral features of outpatients with somatic symptom disorder in otorhinolaryngology clinics.

OBJECTIVE: In the Otorhinolaryngology Department, patients exhibiting somatic symptoms without a medical cause are frequently neglected and left untreated. The aim of this study was to characterize the psychosomatic features of outpatients with somatic symptom disorder (SSD) to better identify patients needing treatment. METHODS: This cross-sectional study enrolled 883 consecutive patients with medically unexplained symptoms. A semistructured clinical interview was employed to confirm the diagnosis of SSD. Data, including sociodemographic and clinical measures, were collected. The Patient Health Questionnaire-15 (PHQ-15) and Somatic Symptom Scale-China (SSS-CN) were used to assess the severity of somatic symptoms; the Patient Health Questionnaire-9 (PHQ-9) was used to assess depression; the General Anxiety Disorder-7 (GAD-7) was used to assess anxiety; and the 12-item Short-form Health Survey (SF-12) was used to assess quality of life (QoL). RESULTS: Based on the DSM-5 criteria, 641 patients were placed in the SSD group, and 212 were placed in the normal group. Compared with the normal group, the SSD group had significantly more doctor visits, longer symptom durations, higher GAD-7 and PHQ-9 scores, and lower physical composite scores (PCSs) and mental composite scores (MCSs). Spearman's correlation analysis and multiple linear regression analyses showed that the SSS-CN score, PHQ-15 score and the patient's subjective feeling that his or her daily life was affected by the disorder were significant risk factors for low PCSs; the SSS-CN, PHQ-15, PHQ-9, and GAD-7 scores were independent risk factors for low MCSs. CONCLUSION: Our findings demonstrated that SSD patients are not rare in otorhinolaryngology clinics in China and that their QoL is significantly affected by SSD. Otolaryngologists should thoroughly evaluate these patients from the perspective of psychosomatic medicine.

Eustachian tube dysfunction in patients with house dust mite-allergic rhinitis.

BACKGROUND: One of the important pathogeneses of eustachian tube dysfunction (ETD) is nasal inflammatory disease. The prevalence of allergic rhinitis (AR) in adults ranges from 10 to 30% worldwide. However, research on the status of eustachian tubes in AR patients is still very limited. METHODS: This prospective controlled cross-sectional study recruited 59 volunteers and 59 patients with AR from Sun Yat-sen Memorial Hospital. Visual analogue scale (VAS) scores for AR symptoms and seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores were collected for both groups. Nasal endoscopy, tympanography and eustachian tube pressure measurement (tubomanometry, TMM) were used for objective assessment. All AR patients underwent 1 month of treatment with mometasone furoate nasal spray and oral loratadine. Then, the nasal condition and eustachian tube status were again evaluated. RESULTS: TMM examination revealed that 22 patients (39 ears, 33.1%) among the AR patients and 5 healthy controls (7 ears, 5.9%) had abnormal eustachian pressure. Twenty-two AR patients (37.3%) and 9 healthy controls had an ETDQ-7 score ≥ 15. With regard to nasal symptoms of AR, the VAS scores of nasal obstruction were correlated with the ETDQ-7 scores, and the correlation coefficient was r = 0.5124 (p < 0.0001). Nasal endoscopic scores were also positively correlated with ETDQ-7 scores, with a correlation coefficient of 0.7328 (p < 0.0001). After 1 month of treatment, VAS scores of nasal symptoms, endoscopic scores and ETDQ-7 scores were significantly decreased in AR patients (p < 0.0001), and TMM examination also suggested that eustachian tube function was significantly improved after treatment (p < 0.0001). CONCLUSIONS: AR patients, especially those with severe nasal obstruction, could have ETD. The local conditions of the pharyngeal orifices of the eustachian tubes are closely related to the symptoms of ETD. After treatment with nasal glucocorticoids and oral antihistamines, eustachian tube function can significantly improve as nasal symptoms subside.Trial registration Chinese Clinical Trial Registery (ChiCTR2000029071) Registered 12 January 2020-Retrospectively registered, http://www.chictr.org.cn/edit.aspx?pid=48328&htm=4.

WDPCP Modulates Cilia Beating Through the MAPK/ERK Pathway in Chronic Rhinosinusitis With Nasal Polyps.

Cilia loss and dysfunction is one of the typical pathological features of chronic rhinosinusitis with nasal polyps (CRSwNP). Tryptophan-aspartic acid (W-D) repeat containing planar cell polarity effector (WDPCP) has been proven to be an essential element for ciliogenesis in human nasal epithelium, but its role in the beating of cilia remains unclear. In this study, we sought to investigate the role of WDPCP and its underlying mechanism behind the dysfunction in the beating of cilia in nasal polyp tissue. We demonstrated WDPCP expression in the epithelium of nasal polyps. We also investigated the MAPK/ERK pathway in primary human sinonasal epithelial cells to explore the function of WDPCP. The air-liquid interface culture system was used as a model to verify the role of WDPCP and the MAPK/ERK pathway in the beating of cilia. With the dysfunction of cilia beating, we observed a low expression of WDPCP in the epithelium of nasal polyp tissues. Within the in vitro study, we found that WDPCP was critical for mitochondrial biogenesis and mitochondrial function in human sinonasal epithelial cells, possibly due to the activation of the MAPK/ERK pathway. The mitochondrial dysfunction caused by U0126 or lacking WDPCP could be partially recovered by dexamethasone. The low expression of WDPCP in nasal epithelium could affect mitochondria via the MAPK/ERK pathway, which may contribute to the dysfunction in the beating of cilia in CRSwNP.

Interleukin-4-induced posttranscriptional gene regulation of CCL26 by the RNA-binding protein HuR in primary human nasal polyp-derived epithelial cells.

BACKGROUND: Much attention on the pathophysiology of nasal polyp (NP) has focused on eosinophils. Interleukin (IL)-4 and eotaxin-3 (C-C motif chemokine ligand 26, or CCL26) levels have been reported to be increased in eosinophilic nasal polyps. The aim of this study was to characterize CCL26 posttranscriptional regulation by the RNA-binding protein HuR in primary human nasal polyp-derived epithelial cells (hNPDECs) challenged with IL-4. METHODS: A prospective, observational study was conducted. Nasal polyp tissues were obtained from eosinophilic (n = 12) and non-eosinophilic (n = 10) NP patients, and inferior turbinate (IT) tissues were taken from control subjects (n = 9) and cultured into hNPDECs. Expression of HuR and CCL26 were measured by immunohistochemistry, Western blot analysis, enzyme-linked immunoassay, and real-time polymerase chain reaction (PCR). The nucleocytoplasmic shuttling of HuR in hNPDECs was detected by immunofluorescence. Posttranscriptional regulation of CCL26 by HuR was tested by ribonucleoprotein immunoprecipitation assay (RIP) and dual-luciferase reporter assay. CCL26 mRNA stabilization was measured by quatititative PCR after treatment with actinomycin D. Student's t test and one-way analysis of variance were used. RESULTS: Immunohistochemical data show that both HuR and CCL26 were highly expressed in NP tissues, especially eosinophilic NP tissues (p < 0.05). IL-4 stimulation increased CCL26 mRNA stability, and overexpression and knockdown of HuR affected CCL26 expression. Immunofluorescence data indicate that IL-4 altered the subcellular distribution of HuR. The RIP and dual-luciferase reporter assay results supply strong evidence for HuR binding to CCL26. CONCLUSION: Our results provide strong support for the hypothesis that IL-4-induced expression of CCL26 in hNPDECs relies partly on CCL26 mRNA stabilization mediated by the interaction of HuR with CCL26 3'UTR.

Intralesional bleomycin A5 injection for the treatment of nasal polyps through inducing apoptosis.

CONCLUSION: An intralesional bleomycin A5 (BLE) injection might be used as an alternative therapy for eosinophilic-type nasal polyps (NPs). BLE-induced apoptosis might play an important role in shrinkage of NPs. OBJECTIVES: The aim of this study is to determine the effect and explore the possible role of apoptosis in shrinkage of NPs. METHODS: Twenty-nine patients with eosinophilic-type NPs experienced repeated local injection of BLE. The recurrence rate of this group was obtained. The mechanism of BLE treatment was investigated through an in vitro experiment. Nasal polyp tissues were treated with BLE. The apoptotic activity was detected by the presence of DNA smear and test of terminal deoxynucleotidyl transferase dUTP nick end labeling. The caspase-8 and PARP were examined through immunohistochemistry and Western blotting. RESULTS: After several local injections of BLE, the nasal polyp tissues decreased and then disappeared. During follow-up of 3 years the recurrence rate of this group was significantly lower than another one treated with operation plus medicine treatment. Apoptosis in BLE-treated tissue was prominently detected in the infiltrating inflammatory cells. The expression of PARP and casp-8 were increased in BLE-treated nasal polyp tissue compared with PBS-treated tissue.

Allergic fungal sinusitis caused by Schizophyllum commune.

A case of allergic fungal sinusitis (AFS) due to Schizophyllum commune was reported. The pathogen was identified using molecular bioanalysis. The patient underwent the functional endoscopic sinus surgery followed by the radical maxillary sinusotomy with canine fossa trephine. This case suggested that complete surgery allowed optimal disease clearance for AFS caused by Schizophyllum commune.

Exploring the natural chemiome to target interleukin-6 receptor (IL-6R) cytokines: an atomic scale investigation for novel rheumatoid arthritis drug discovery

ABSTRACT Natural compounds are a gold mine for treating rheumatoid arthritis (RA). The etiology of this disease is linked to inflammation, where cytokines play an important role. Strategies have been drafted for targeting cytokines as a therapeutic option in patients with RA. Inhibiting cytokines with natural compounds has become a major focus for the development of drugs to treat RA. Here, a structure-based drug design approach was employed to identify novel leads to target the interleukin 6 receptor (IL-6R). A total of 48,531 compounds of natural origin were screened. Two of these compounds were shortlisted for molecular docking simulation and tested for inhibiting gp130 dimerization in human macrophages. The results show that Lead5 (CID5329098) significantly inhibited the release of gp130 in a dose-dependent manner, similar to the inhibitory effect of LMT-28 (p<0.005). This study provides an atomic scale outcome of a single natural compound that can be developed into a RA drug

Negative suction approach to remove living leeches from the nasal cavity.

OBJECTIVE: To explore a method for removing a living leech from the nasal cavity. MATERIALS AND METHODS: A total of 5 patients with nasal leech were examined. Nasal endoscopy revealed the presence of a wriggling leech in the nasal cavities of each of these patients. A negative suction tube with an inner diameter of 3 mm and a negative pressure of 30-40 kp was used to remove these leeches. In each case, this suction tube was aimed at the free end of the leech, and the leech was gradually and slowly sucked into the tube. The suckers of the removed leeches were examined to ensure that no leech fragments remained within each patient. RESULTS: In all 5 cases, the intact leech was successfully removed. No surgical complications occurred. CONCLUSIONS: The negative suction method can successfully remove nasal leeches.

Increased expression of dectin-1 in nasal polyps.

PURPOSE: A fungal etiology has been proposed to underlie severe nasal polyps (NP). Dectin-1 is an innate immune pattern recognition receptor which is involved in the recognition of some pathogenic fungi. We investigated the Dectin-1 levels in NP in order to evaluate the implication of such expression with respect to the development of NP. MATERIALS AND METHODS: Normal inferior turbinate tissues were obtained from forty patients undergoing surgery for augmentation rhinoplasty. Nasal polyp tissues were obtained from 53 patients who underwent endoscopic sinus surgery for chronic polypoid rhinosinusitis. Real-time polymerase chain reaction and Western blot analysis were performed to evaluate the mRNA and protein level of Dectin-1, respectively. ELISA was carried out to evaluate the cytokine production (IL-4, IL-5, IL-10, and TNF-α) in NP. RESULTS: Real-time polymerase chain reaction and Western-blot analysis showed that Dectin-1 expression in NP was increased compared with that in normal nasal inferior turbinate tissues. ELISA results suggest that the local expression of type-1 and type-2 inflammatory cytokine is skewed toward type-2 inflammatory cytokine in NP. CONCLUSIONS: These results suggest that Dectin-1 may play a role in the development of NP, and the production of Dectin-1, IL-4 and IL-5 (type-2 cytokines), may mainly participate in the inflammatory reaction in NP.

The diagnostic value of narrow-band imaging for the detection of nasopharyngeal carcinoma.

OBJECTIVES: To evaluate the diagnostic value of narrow-band imaging (NBI) for the detection of nasopharyngeal carcinoma (NPC). STUDY DESIGN: Prospective study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Between December 2009 and June 2010, a total of 1,854 patients were examined by means of an electronic nasopharyngolaryngoscope equipped with conventional white light (WL) and an NBI system. The sensitivity, specificity and positive/negative predictive values for detecting NPC were calculated and compared. RESULTS: Of these patients, 62 cases (3.34%) were pathologically confirmed as NPC. The sensitivity, specificity, positive predictive value and negative predictive value for detecting NPC significantly increased from 90.3, 75.4, 11.3 and 99.6% with WL up to 100, 99.2, 81.6 and 100% with NBI, respectively. CONCLUSION: Our findings suggested that NBI endoscopy might serve as an ideal tool in the detection of NPC.

[Analysis of psychoacoustic characteristics and audiology tests of tinnitus patients with sensorineural hearing loss].

OBJECTIVE: Tried to find the relationship between tinnitus and each testing method, provided information for objective diagnosis and treatment for tinnitus patients with sensorineural hearing loss. METHOD: The characteristics of audiology tests, including pure tone audiometric, acoustic immittance, middle ear muscle reflexes, matching test, distortion products otoacoustic emission(DPOAE) were compared in 79 ears of 69 tinnitus patients with sensorineural hearing loss. RESULT: The RI positive rate was higher in Convergence curve in tinnitus patients of sensorineural hearing loss, with the rate being 51.3%. The detection rates of DPOAE were 15.2% in patients of sensorineural hearing loss tinnitus groups, which were significant lower than those in control group. CONCLUSION: Psychoacoustic techniques can produce a useful amount of clinical data regarding tinnitus in different aspects, these data can help clinicians design needed based managements. DPOAE test is helpful for the diagnosis of lesions in some tinnitus patients.

[Association of regulatory region of HLA-DPB1 with nasopharyngeal carcinoma in southern Chinese Hans].

OBJECTIVE: To clarify the association between regulatory region of HLA-DPB1 (3'UTR) with Naso pharyngeal carcinoma in Guangdong Province Hans. METHOD: The allelic types of HLA-DPB1-3'UTR were detected by sequence specific primer (SSP) in 104 patients with NPC and 105 control individuals from Guangdong Province Hans. RESULT: The frequencies of allelic types B/B, haplotype B were higher in patients with NPC than those of the control individuals. CONCLUSION: Positive association may exist between certain HLA-DPB1 alleles and NPC in Guangdong Province Hans.

[Relationship between expression of inducible nitric oxide synthase in nasal mucosa and outcome after endoscopic sinus surgery].

OBJECTIVE: To explore the role of the inducible nitric oxide synthase (iNOS) in the physiological mechanism of chronic rhinosinusitis (CRS), and to elucidate the relationship between the expression of iNOS in nasal mucosa and the outcome of endoscopic sinus surgery (ESS). METHOD: Thirty-one patients of CRS were divided into two groups according to the levels of IgE in blood serum: Group A with high levels of serum TIgE (TIgE > or = 90 kU/L) and Group B with low levels of serum TIgE (TIgE < 90 kU/L). Immunohistochemical procedures were taken to determine the expression of iNOS in the nasal mucosa of each CRS patient, and the CT scans of sinuses were evaluated by the Lund-Mackay CT staging system. The time of the operative cavity epithelialized (OCE) was recorded by the unit of week. Associated between time of OCE and the the expression of iNOS or the CT staging was analyzed. RESULT: The time of OCE was positive correlated with the expression of iNOS in Group A (P < 0.05) and did not show a clear correlation with the CT staging, while in Group B it was positive correlated with the CT staging (P < 0.05) and did not correlate with the expression of iNOS. CONCLUSION: iNOS may be a predictive factor in the outcome of ESS. In cases of CRS patients with high levels of TIgE, time of OCE is positive correlated with the expression of iNOS in the nasal mucosa.

[The management of the stoma in endoscopic dacryocystorhinostomy].

OBJECTIVE: To explore the better management of the stoma in endoscopic dacryocystorhinostomy. METHOD: To review the 102 chronic dacryocystitis patients (109 eyes), who underwent the endoscopic dacryocystorhinostomy surgery with silver clips used to maintain the stoma. They were given combined therapy after the surgery, and were followed up for a period range from 3-73 months. RESULT: 99/109 eyes (91%) were cured, 5/109 eyes (4.5%) were improved, and the total effective rate reached to 104/109 (95.5%). CONCLUSION: The application of silver clip in endoscopy dacryocystorhinostomy surgery and combined therapy after the surgery can effectively prevent the stoma stenosis or atresia.

[Diagnosis of recurrent or residual nasopharyngeal carcinomas in the skull base area with F-18-fluoro-deoxyglucose positron emission tomography].

OBJECTIVE: To investigate the diagnostic value of F-18-fluoro-deoxyglucose positron emission tomography (FDG-PET) for the recurrent or residual nasopharyngeal carcinomas in the skull base area. METHODS: Nine post-irradiation nasopharyngeal carcinoma patients did FDG-PET scanning, CT/MRI imaging and underwent nasopharynx and skull base-biopsy under endoscopy. The results of FDG-PET were evaluated and compared with CT/MRI studies and biopsies. RESULTS: In 9 cases of post-irradiation nasopharyngeal carcinoma, CT/MRI detected 7 recurrent cases and 2 suspected recurrent cases in occipital bone and clivus. All 9 cases had accumulated FDG in nasopharynx and cranial base. A definite diagnosis was made by biopsy, 3 cases were confirmed recurrence, and others 6 cases were proved mucous chronic inflammation and (or) osteoradionecrosis. The accuracy of FDG-PET was 33.3% (3/9), and the false positive rate was 66.7% (6/9). CONCLUSIONS: Diagnosis of recurrent or residual nasopharyngeal carcinomas in the skull base area with FDG-PET had high false-positive rate, final diagnosis must depend on histopathologic examination under endoscopy.

[The effect of the size of tonsil on uvulopalatopharyngoplasty].

OBJECTIVE: To investigate how the size of tonsil affects the curative effect of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) treated with Uvulopalatopharyngoplasty (UPPP). METHOD: Fifty-four cases with OSAHS treated with UPPP in our department were analyzed retrospectively. The polysomnography (PSG) was examined again one years or longer after operation. RESULT: There was no statistical difference between different tonsil size groups in age, apnea-hypopnea index (AHI), body mass index (BMI) and the lowest Pulse Oxygen Saturation (lowest SpO2) before operation. But there was a statistical difference in curative effect after operation between groups. The lowest SpO2 raised obviously in groups with bigger tonsils. In serious OSAHS group, there was a statistical difference in the composing of tonsil size grade in different curative effect groups. CONCLUSION: Patients with bigger size of tonsil will receive a better result after UPPP while the lowest SpO2 will be improved more prominent. To serious OSAHS, we should treat them individually.

[Value of CT scan in the early diagnosis of nasopharyngeal tumor].

OBJECTIVE: To evaluate the clinical value of CT scan on the early diagnosis of nasopharyngeal masses. METHOD: The results of CT scans and pathological findings to the 59 cases of localized nasopharyngeal masses were summerized. RESULT: Among the 44 cases diagnosed by CT scan as nasopharyngeal carcinoma, their pathological findings revealed 35 cases of nasopharyngeal carcinoma, 2 cases of non Hodgkin's disease, 3 cases of nasopharyngeal tuberculosis, 3 cases of nasopharyngeal lymphadenosis, and 1 case of nasopharyngeal cyst. Among the 11 cases diagnosed by CT scan as local mucal thicking, their pathological findings demonstrated 2 cases of nasopharyngeal carcinoma, 6 cases of chronic inflammation, 1 case of nasopharyngeal tuberculosis, and 2 case of nasopharyngeal cyst. The other 4 cases diagnosed by CT scan as nasopharyngeal fibrohemangioma were confirmed by pathological examination. CONCLUSION: CT scan can correctly reveal nasopharyngeal diseases, and benefit early diagnosis. It shows distinctive advanteges in detecting early stage of submucal nasopharyngeal carcinoma and diagnosing nasopharyngeal fibrohemangioma. But there is limitation in differentiating common nasopharyngeal diseases.