Different roles of Staphylococcus aureus enterotoxin in different subtypes of nasal polyps.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial disease. The pathogenesis of CRSwNP remains unclear. This study was designed to investigate the role of inflammation and Staphylococcus aureus enterotoxin (SE) in this disease. The study included a total of 74 patients with CRSwNP and 6 controls. A serum Phadiatop assay was conducted to detect atopy status, and serum eosinophil cationic protein (ECP) and total immunoglobulin (Ig)E levels were determined using ELISA. SEA, SEB, total IgE, ECP and myeloperoxidase (MPO) levels in nasal tissue supernatant were measured using ELISA. The results indicated that 15 (22.1%) patients had systemic allergies. On the basis of the ECP/MPO ratio, the patients were divided into an eosinophilic CRSwNP group (n=18) and a non-eosinophilic CRSwNP group (n=56). The total ECP/MPO ratio was 0.572, with a notable bias toward neutrophilic inflammation. The supernatant ECP and MPO levels were elevated in the CRSwNP group compared with the control group, but no significant difference in the serum total IgE and ECP levels were observed between the CRSwNP and control groups. In addition, the non-eosinophilic and eosinophilic CRSwNP groups showed significant elevations in supernatant total IgE, SEA and SEB levels compared with the control group. Thus, it may be concluded that allergy is a common pathogenesis of CRSwNP, and neutrophilic inflammation is present in most Chinese CRSwNP patients. Additionally, local indicators reflect the inflammatory status more accurately than do serum indicators. SEs may act as an infection factor rather than as a superantigen in Chinese non-eosinophilic CRSwNP patients. Thus, long-term antibiotic therapy may be an option for Chinese non-eosinophilic CRSwNP patients.

Copper(II)-Silver(I) Macrocyclic Metal-Organic Framework: A Highly Efficient Reusable Triplet Oxygen Collector and Singlet Oxygen Generator.

The generation of highly reactive oxygen (1O2) is very significant for a variety of applications such as degradation, bleaching, chemical synthesis, photodynamic therapy for tumor treatment, and others. Herein, we report a novel peroxide-dianion-embedded bimetallic macrocycle, [O22-@Ag4Cu4L4]2+ (2), that can completely release the inserted peroxide dianion as the singlet oxygen (1O2) via a H+-assisted disproportionation process in methanol. Notably, the resulting empty Ag4Cu4L4(ClO4)4 (3) is able to trap oxygen (3O2) from air and fixes it in the macrocycle host as a peroxide dianion; furthermore, it releases it as 1O2 again in the presence of H+. So, the bimetallic macrocycle [Ag4Cu4L4]4+ herein behaves as a highly efficient reusable triplet oxygen receptor and singlet oxygen generator.

Understanding of the low temperature auto-oxidation scheme of sec-alcohols based on a Cu(II)-MOF with open metal sites.

A Cu(II)-MOF (1') with open metal sites was readily obtained by removing the coordinated water molecule at 120 °C. It can be used as a probe to evidence the sec-alkyl hydroperoxide species generated from room temperature sec-alcohol auto-oxidation in air. The formed alkyl hydroperoxides can be effectively catalyzed by 1' to decompose into molecular oxygen and corresponding sec-alcohols under ambient conditions.

A case report of an inflammatory myofibroblastic tumor of the neck: A focus on the computed tomography and magnetic resonance imaging findings.

Inflammatory myofibroblastic tumors (IMTs) of the neck are rare, with only a few patients reported in the literature. The present study discusses the clinical manifestations, radiographic characteristics and management of these tumors, with a focus on imaging modalities. A case of IMT of the neck is presented and the associated literature is reviewed. In total, seven patients in seven English-language studies, including the present case, and one patient in one Chinese-language study were found. On CT scans, all tumors appeared as soft-tissue densities. Upon magnetic resonance imaging (MRI), all tumors displayed a heterogeneous hypointense-isointense signal on T1-weighted sequences and an isointense-hyperintense signal on T2-weighted sequences. All tumors showed enhancement on enhanced CT and MR images. The imaging features of the neck IMTs can be summarized as follows: i) When enhanced, the tumor displays enhancement on CT and MR images; ii) MRI is superior to CT scans in the differential diagnosis of this disease; iii) in general, the lesion displays a hypointense-isointense signal on T1-weighted sequences and an isointense-hyperintense signal on T2-weighted sequences; iv) due to the fibrous tissue in the tumor, delayed enhancement may be observed on gadolinium-enhanced MR images; and v) due to its benign or intermediate features, the tumor is usually a well-defined mass.

Endoscopic prelacrimal recess approach adjunct with vestibular sulcus incision: case report of a minimally invasive access to remove infratemporal fossa tumor.

To remove tumor located at anterolateral-inferior of infratemporal fossa (ITF) with purely transnasal approach is still a great challenge because of the over lateral angulation. The aim of this study is to present our initial experience--endoscopic prelacrimal recess approach adjunct with vestibular sulcus incision as a simple and minimally invasive approach to remove tumor in this area. Tumor in anterolateral ITF can be well explored via endoscopic prelacrimal recess approach; a simple vestibular sulcus incision provides a second access for two-surgeon co-operation, so tumor can be removed conveniently with minimal invasion. It is a viable alternative to endoscopic extended medial maxillectomy approach or open approaches to this area.

Objective assessment of persistent rhinitis in Chinese and its relationship with serum indicators.

Persistent rhinitis (PR) is a chronic disease that affects millions of people. However, it lacks of a useful method, which can indicate the actual severity of the inflammation in PR patients. This study was designed to seek an examination which could reflect the actual severity of PR disease. The serum Phadiatop test, ECP level, four-phase rhinomanometry, and acoustic rhinometry were assessed in 91 adult patients with PR and 10 healthy controls. The serum total IgE was determined in some of the patients and all of the controls. The patients were divided into four groups: ARWO, ARWTO, NARWO and NARWTO. 40% (22/55) of AR and 33.3% (13/36) of NAR patients never complained of persistent nasal obstruction. Serum ECP levels were increased in the ARWO group. Serum total IgE was significantly elevated in the AR groups. MCA(1-Min) and MCA(1-T) were significantly reduced in the ARWO, ARWTO, and NARWO groups. NV(6-Min) and NV(6-T) were decreased in all PR groups, but only some of these differences were significant. In the ARWO group, MCA(2-Min) (r = -0.252), MCA(2-T) (r = -0.377), NV(6-Min) (r = -0.32), and NV(6-T) (r = -0.311) had significant relationships with serum ECP. We recommend acoustic rhinometry as a useful routine tool for the diagnosis of PR, even among patients without persistent subjective nasal obstruction. This technique might reveal the actual status of nasal congestion. An elevated serum ECP level might indicate severe AR and is negatively correlated with the results of acoustic rhinometry.

Obstructive sleep apnea syndrome caused by uncommon tumors of the upper aerodigestive tract.

Obstructive sleep apnea syndrome (OSAS) is always caused by anatomic abnormalities, including nasal cavity, pharynx, and neuromuscular dysfunctions, leading to airway narrowing. OSAS associated with a mass in the aerodigestive tract is rare. In the present study, we report OSAS caused by 9 cases of preoperative uncommon tumors in the aerodigestive tract. Two tumors in the parapharyngeal space were pleomorphic adenoma, one oropharyngeal tumor was mucoepidermoid carcinoma, one tumor in the right tonsil was schwannoma, and five tumors were non-Hodgkin's lymphoma (NHL). Of the five NHL cases, one in the nasopharynx was diffuse large B-cell lymphoma, two were mantle cell lymphoma, one was chronic lymphocytic leukemia/small lymphocytic lymphoma, and one was NHL. Tumors in the aerodigestive tract should be considered in the differential diagnosis of OSAS upon exacerbation of snoring or sudden gasping. Further examinations should be performed, including a routine workup (computed tomography (CT) and magnetic resonance imaging) and positron emission tomography/CT.

The utility of repeated computed tomography to track a foreign body penetrating the esophagus to the level of the thyroid gland.

OBJECTIVE: Foreign body (FB) ingestion is a common problem in otolaryngology. One uncommon complication of FB ingestion is penetration to the level of the thyroid gland. To our knowledge, only 21 such cases have been reported in the literature. Here, we report a case of an esophageal FB penetrating to the level of the right thyroid gland. CASE REPORT: The patient was a 38-year-old woman in whom an esophageal FB penetrated to the level of the right thyroid gland. We traced the path to the thyroid gland using repeated computed tomography (CT) scans and demonstrated the importance of multiplanar reconstruction in locating the FB and formulating a precise surgical plan. CONCLUSIONS: To our knowledge, this is the first report of repeat CT scans being used to demonstrate the migratory route, over time, of a FB penetrating through the esophagus to the level of the thyroid gland. Our results suggest that multiplanar reconstruction may play a key role in the precise diagnosis of a FB at the level of the thyroid gland and may help surgeons choose the best approach for removal.

Effect of the vascular endothelial growth factor expression level on angiopoietin-2-mediated nasopharyngeal carcinoma growth.

BACKGROUND: The overexpression of angiopoietin-2 (Ang-2) has both pro-tumorigenic and anti-tumorigenic effects. However, the mechanisms of this protein's dual effects are poorly understood, and it remains unclear how Ang-2 cooperates with vascular endothelial growth factor (VEGF). In the current study, we investigated the effects of Ang-2 overexpression on nasopharyngeal carcinoma growth in the presence of different levels of VEGF. METHODS: Ang-2 was introduced into the CNE2 cell line by liposome transfection, and the expression of endogenous VEGF was inhibited by microRNA-mediated RNA interference. CNE2 cells expressing varying levels of Ang-2 and VEGF were injected subcutaneously into the flanks of nude mice. Tumor growth was measured, and vessels from the harvested tumors were analyzed. RESULTS: The overexpression of Ang-2 had no obvious effect on CNE2 tumor growth in the presence of endogenous VEGF but significantly inhibited CNE2 tumor growth when the expression of endogenous VEGF was silenced, and the Ang-2/VEGF ratio is negatively correlated with tumor growth. Ang-2 overexpression decreased the percentage of α-SMA-positive cells around the tumor vessels but reduced the microvessel density only in the absence of VEGF. CONCLUSIONS: Our results indicate that the effects of Ang-2 on nasopharyngeal carcinoma are highly dependent on the level of VEGF expression, Ang-2/VEGF ratio may offer a novel therapeutic approach for treating human cancer.

Cu(II)4L4 coordination-driven molecular container: a reusable visual colorimetric sensor for Ag(I) ions.

A Cu4L4 square-like molecular container which can be a reusable visual sensor for Ag(+) is reported. The present results can be a useful stepwise approach for the construction of the heterometallic supramolecular complexes with potential applications.

Giant osteomas of the ethmoid and frontal sinuses: Clinical characteristics and review of the literature.

Giant osteomas of the ethmoid and frontal sinuses ary very rare, with only a few dozen cases reported in the literature. Given their rarity, the clinical characteristics and treatment of this disease remain controversial. In this study, the clinical presentation and surgical methods used to treat three patients with giant osteomas of the ethmoid and frontal sinuses are described, combined with a review of the literature from 1975 to 2011. In total, 45 patients with giant osteomas arising from the ethmoid and frontal sinuses (including the present cases) have been reported in 41 articles. Headache and ocular signs are the most common symptoms. This disease often leads to intracranial or intraorbital complications. The main treatment for giant osteoma is surgery via an external approach. The outcome of surgery for giant osteoma is good, with rare recurrence, no malignant transformation and few persistent symptoms.

Serum eosinophil cationic protein level in Chinese subjects with nonallergic and local allergic rhinitis and its relation to the severity of disease.

BACKGROUND: Nonallergic rhinitis (NAR) is a common disease, and local allergic rhinitis (LAR) is a newly described entity that is called "entopy" in recent years. However, the etiology and incidence of NAR and LAR are uncertain. This study evaluates the incidence of LAR in Chinese subjects and serum eosinophil cationic protein (ECP) levels in patients with NAR and LAR and its relationship with symptom scores. METHODS: Positive skin-prick tests (SPT), nasal allergen provocation testing (NAPT) to Dermatophagoides farinae (DF), serum Phadiatop tests, and symptom score evaluations were performed in 147 patients with nonatopic persistent rhinitis. LAR was diagnosed by positive NAPT to DF results. The serum ECP level was measured using the UniCAP100 automated system by enzyme-linked immunosorbent assay (Pharmacia Diagnostics, Uppsala, Sweden). RESULTS: Twelve patients were diagnosed with LAR, and 135 patients were diagnosed with NAR. There was no statistical difference of the visual analog scale scores between the two groups. Serum ECP was significantly increased in the patients with NAR. Serum ECP in the LAR group showed no difference compared with the NAR group or the controls. In the NAR group, nasal obstruction, rhinorrhea, and total scores had close and statistically significant relationships with serum ECP level. CONCLUSION: The present study provides the first evidence that LAR exists in Chinese subjects. This study also suggests that eosinophils and ECP take part in the pathogenesis of NAR. A local examination for ECP and specific IgE in nasal lavage fluid or secretions in patients with LAR should be performed in a future study.

Bacterial biofilms in chronic rhinosinusitis and their relationship with inflammation severity.

AIMS: To identify the presence of bacterial biofilms on mucosal specimens from chronic rhinosinusitis (CRS) patients, and evaluate their relationship with severity of CRS. METHODS: A prospective study of biofilms presence on 24 CRS patients compared with 12 controls was designed. The presence of biofilms was determined by scanning electron microscopy (SEM), and associations with the preoperative Lund-MacKay CT scores, Johansson endoscopic scores, and the history of ESS were assessed. RESULTS: Biofilms were found in 13/24 CRS patients (54.2%) but in only 1/12 controls (8.3%; P<0.01). CRS patients with and without biofilms had similar preoperative Lund-MacKay CT and Johansson endoscopic scores (P>0.05). Patients with revision ESS showed a tendency of higher biofilms incidence (5/7, 71.4%) than those undergoing their first procedure (8/17, 47.1%), but did not reach a significant difference (P>0.05). CONCLUSIONS: The higher incidence of biofilms in CRS patients suggests a role in the pathogenesis of CRS, but no correlation with severity of CRS.

Factors associated with recurrence and therapeutic strategies for sinonasal Rosai-Dorfman disease.

BACKGROUND: The purpose of this study was to explore the factors associated with the recurrence of Rosai-Dorfman disease (RDD) in the nasal cavity and paranasal sinus. METHODS: In this study, we conducted a review of the English-language literature published between 1969 and 2010 on the recurrence of and treatment strategies for sinonasal RDD. RESULTS: To our knowledge, 126 cases of RDD have been reported to date. Of the 126 patients, 32 (25.4%) had no recurrence or were alive with no evidence of disease; remission occurred in only 1 patient (0.7%); 69 patients (54.8%) had a recurrent, persistent, or progressive course; and 6 patients (4.8%) died from the disease. In patients with recurrent, persistent, and progressive disease, there was no significant tendency for lymph node involvement. CONCLUSION: Sinonasal RDD is generally described as benign. However, recurrence and fatal outcome have been reported. Our results suggest that the initial modality may affect the recurrence of RDD.

[Relationship between bacterial biofilms and chronic rhinosinusitis by scanning electron microscopic study].

OBJECTIVE: To determine the presence and the morphological features of bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis (CRS) compared with control patients without CRS by scanning electron microscopy (SEM), and to evaluate the role of biofilm on the pathogenesis of CRS. METHODS: Fifteen patients with CRS undergoing endoscopic sinus surgery and 11 control patients with fracture of nasal bone were enrolled in this study. Clinical information was recorded from each patient. All patients underwent a thorough otolaryngological examination, preoperative paranasal sinus computerized tomography (CT) scanning which were evaluated according to the Lund-Mckay CT scoring system. All the samples including uncinate process, ethmoid mucosa from CRS group and uncinate process, ethmoid bulla from control group were prepared using standard methods for SEM. The presence of bacterial biofilms on the samples of two groups was observed by SEM. Statistical analysis was performed using SPSS 13.0. Continuous data was analyzed by Student t test and dichotomous data was analyzed by chi² or Fisher exact test. P was considered to be significant at a level of 0.05. RESULTS: Nine (60.0%) of the 15 patients were found to have evidence of biofilms. In control group, only 1 (9.1%) of 11 patients had biofilm. The difference was statistical significant (chi² = 6.949, P < 0.01). All controls except one had healthy appearing cilia and goblet cells without biofilms. All the 16 CRS patients showed aberrant findings of the mucosal surface with variation in degrees of severity from disarrayed cilia to complete absence of cilia and goblet cells. Among them the typical morphologic feature such as water channels, 3-D structure, and matrix-embedding spherical or elliptical bodies were noted in 9 cases. Five samples including one case from control showed cilia aggregation. The preoperative CT scores of the CRS patients with biofilms (n = 9) were significantly higher than those without biofilms (n = 6, t = 2.14, P < 0.05). CONCLUSIONS: The typical morphologic feature of BF such as water channels, 3-D structure, and matrix-embedding spherical or elliptical bodies were noted in sinus mucosa of patients with CRS by the SEM. The positive rate of bacterial biofilms in CRS group was significantly higher compared to control group, which indicated bacterial biofilms might play an important role in the pathogenesis of CRS. Besides the typical bacterial biofilm features, cilia aggregation was found in five cases of CRS patients. We consider cilia aggregation can be regarded as one morphologic feature of bacterial biofilm in nasal mucosa, which needs further study. The presence of bacterial biofilms in CRS patients is associated with paranasal CT scores, which indicates that bacterial biofilm is correlated with the severity of CRS.

Changing trends in the clinical features of laryngeal tuberculosis: a report of 19 cases.

OBJECTIVE: This study was undertaken to evaluate the changing trends in the clinical features of laryngeal tuberculosis, with the goal of reducing misdiagnosis and incorrect treatment. METHODS: A retrospective clinical analysis compared the clinical patterns in five cases with pathologically confirmed laryngeal tuberculosis seen before 1990 with those of 14 cases of laryngeal tuberculosis seen after 1998. RESULTS: The five patients seen before 1990 ranged in age from 19 to 41 years of age, with a mean of 32 years. The most frequent chief complaint was odynophagia accompanying system symptoms and pulmonary tuberculosis. The posterior part of the larynx was commonly involved and the lesions tended to be ulcerative and multiple. The 14 patients seen after 1998 were aged from 17 to 71 years with a mean age of 49.9 years. The most frequent chief complaint was hoarseness (71.4%). The most common lesion site was in the true vocal cords (57.2%). Most of patients with normal lung status had single, nonspecific, polypoid lesions. Stroboscopy revealed four different appearances. CONCLUSIONS: Laryngeal tuberculosis may occur even without pulmonary tuberculosis, and the characteristics of the lesions appear to be more nonspecific. It is important to consider tuberculosis in the differential diagnosis of laryngeal disease.

[Treatment of allergic rhinitis with nasal mometasone furoate].

OBJECTIVE: To evaluate the effects of nasal mometasone furoate on moderate to severe allergic rhinitis. METHODS: Patients with moderate to severe allergic rhinitis were enrolled and received mometasone furoate nasal spray 200 microg once daily for four weeks. Four hundreds and sixty-three patients completed the study. We weekly interviewed the patients to evaluate the symptoms, and the affection of disease on night sleep and daily life. Mini Rhinoconjunctivitis Quality of Life Questionnaire (Mini-RQLQ) and Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ) were used to evaluate the quality of life. RESULTS: The individual and total symptomatic scores of week 1, week 2 and week 4 decreased compared with baseline. The scores of Mini-RQLQ and NRQLQ of week 1, week 2 and week 4 decreased compared with baseline too. The scores of the next visit were significantly lower than those of the previous visit (P < 0.01). CONCLUSIONS: A four-week administration of mometasone furoate nasal spray can effectively treat allergic rhinitis.