Effect of nicotine on Staphylococcus aureus biofilm formation and virulence factors.

Staphylococcus aureus is a common pathogen in chronic rhinosinusitis (CRS) patients, the pathogenesis of which involves the ability to form biofilms and produce various virulence factors. Tobacco smoke, another risk factor of CRS, facilitates S. aureus biofilm formation; however, the mechanisms involved are unclear. Here, we studied the effect of nicotine on S. aureus biofilm formation and the expression of virulence-related genes. S. aureus strains isolated from CRS patients and a USA300 strain were treated with nicotine or were untreated (control). Nicotine-treated S. aureus strains showed dose-dependent increases in biofilm formation, lower virulence, enhanced initial attachment, increased extracellular DNA release, and a higher autolysis rate, involving dysregulation of the accessory gene regulator (Agr) quorum-sensing system. Consequently, the expression of autolysis-related genes lytN and atlA, and the percentage of dead cells in biofilms was increased. However, the expression of virulence-related genes, including hla, hlb, pvl, nuc, ssp, spa, sigB, coa, and crtN was downregulated and there was reduced bacterial invasion of A549 human alveolar epithelial cells. The results of this study indicate that nicotine treatment enhances S. aureus biofilm formation by promoting initial attachment and extracellular DNA release but inhibits the virulence of this bacterium.

Nicotine Enhances Staphylococcus epidermidis Biofilm Formation by Altering the Bacterial Autolysis, Extracellular DNA Releasing, and Polysaccharide Intercellular Adhesin Production.

Staphylococcus epidermidis is a common bacterial colonizer of human skin and mucous membranes, yet it has emerged as an important nosocomial pathogen largely due to its ability to form biofilms. Tobacco smoke has been demonstrated as a contributor to various infection diseases by improving the biofilm formation of multiple bacterial species; however, the association between tobacco smoke and S. epidermidis biofilm is still unclear. In this study, we tested the effect of nicotine, one of the most active components of tobacco, on S. epidermidis biofilm formation, and we studied the underlying mechanisms. Our results showed that nicotine promoted the biofilm formation of S. epidermidis 1457 strain (SE1457) and enhanced its initial attachment to a polyethylene surface as well as polysaccharide intercellular adhesin (PIA) production. In addition, an increased extracellular DNA release and a higher autolysis rate of SE1457 was detected after nicotine treatment, which was consistent with the increased ratio of dead cells in nicotine-treated SE1457 biofilm observed with confocal laser-scanning microscopy. Furthermore, the effect of nicotine on several autolysis-related and biofilm-related gene knockout mutants of SE1457 was tested. It showed that in ΔsaeRS, ΔlytSR, and ΔsceD, nicotine induced increase in biofilm formation was similar to that in SE1457; but in ΔarlRS, ΔatlE, and ΔicaC, the effect was obviously impaired. Consistently, the increase of the bacterial autolysis rate in ΔarlRS and ΔatlE induced by nicotine was not as significant as that in SE1457. Meanwhile, the growth inhibition of nicotine on SE1457 was observed, and it was much less on ΔarlRS and restored by the arlRS complementation. The arlRS transcription in SE1457 was inhibited by nicotine during cultivation as indicated by a promoter reporter assay using green fluoresent protein. Taken together, our study indicates that nicotine improves S. epidermidis biofilm formation by promoting its initial attachment and intercellular accumulation; the arlRS, atlE, and ica genes mediating bacterial autolysis and PIA production play an important role in this process.

An In Vitro Model to Study the Effect of 5-Aminolevulinic Acid-mediated Photodynamic Therapy on Staphylococcus aureus Biofilm.

Staphylococcus aureus (S. aureus) is a common human pathogen, which causes pyogenic and systemic infections. S. aureus infections are difficult to eradicate not only due to the emergence of antibiotic-resistant strains but also its ability to form biofilms. Recently, photodynamic therapy (PDT) has been indicated as one of the potential treatments for controlling biofilm infections. However, further studies are required to improve our knowledge of its effect on bacterial biofilms, as well as the underlying mechanisms. This manuscript describes an in vitro model of PDT with 5-aminolevulinic acid (5-ALA), a precursor of the actual photosensitizer, protoporphyrin IX (PpIX). Briefly, mature S. aureus biofilms were incubated with ALA and then exposed to light. Subsequently, the antibacterial effect of ALA-PDT on S. aureus biofilm was quantified by calculating the colony forming units (CFUs) and visualized by viability fluorescent staining via confocal laser scanning microscopy (CLSM). Representative results demonstrated a strong antibacterial effect of ALA-PDT on S. aureus biofilms. This protocol is simple and can be used to develop an in vitro model to study the treatment of S. aureus biofilms with ALA-PDT. In the future, it could also be referenced in PDT studies utilizing other photosensitizers for different bacterial strains with minimal adjustments.

Conditioned medium from umbilical cord mesenchymal stem cells improves nasal mucosa damage by radiation.

OBJECTIVES: To explore therapeutic effects of conditioned medium from human umbilical cord mesenchymal stem cells (hUC-MSCs) on nasal mucosa radiation damage both in vivo and in vitro. RESULTS: The mucus cilia clearance time (7 and 30 days), degree of mucosal edema (7, 30, 90 and 180 days), cilia coverage (180 days) of concentrated conditioned medium group improved compared with radiotherapy control group. The proliferation and migration abilities of irradiated and non-irradiated nasal epithelial cells significantly increased after culture in bronchial epithelial cell growth medium (BEGM) containing 10% conditioned medium of hUC-MSCs compared to cells cultured in BEGM alone. CONCLUSIONS: Soluble factors secreted by hUC-MSCs may promote nasal epithelial cell proliferation and migration. Intranasal administration of hUC-MSC conditioned medium effectively repairs nasal mucosa radiation damage.

5-aminolevulinic acid-mediated photodynamic therapy and its strain-dependent combined effect with antibiotics on Staphylococcus aureus biofilm.

Staphylococcus aureus (S. aureus) is hard to be eradicated, not only due to the emergence of antibiotic resistant strains but also because of its ability to form biofilm. Antibiotics are the major approach to treating biofilm infections, but their effects are unsatisfactory. One of the potential alternative treatments for controlling biofilm infections is photodynamic therapy (PDT), which requires the administration of photosensitizer, followed by light activation. 5-aminolevulinic acid (ALA), a natural photosensitizer prodrug, presents favorable characteristics, such as easy penetration and rapid clearance. These advantages enable ALA-based PDT (ALA-PDT) to be well-tolerated by patients and it can be repeatedly applied without cumulative toxicity or serious side effects. ALA-PDT has been proven to be an effective treatment for multidrug resistant pathogens; however, the study of its effect on S. aureus biofilm is limited. Here, we established our PDT system based on the utilization of ALA and a light-emitting diode, and we tested the effect of ALA-PDT on S. aureus biofilm as well as the combined effect of ALA-PDT and antibiotics on S. aureus biofilm. Our results showed that ALA-PDT has a strong antibacterial effect on S. aureus biofilm, which was confirmed by the confocal laser scanning microscope. We also found that lethal photosensitization occurred predominantly in the upper layer of the biofilm, while the residual live bacteria were located in the lower layer of the biofilm. In addition, the improved bactericidal effect was observed in the combined treatment group but in a strain-dependent manner. Our results suggest that ALA-PDT is a potential alternative approach for future clinical use to treat S. aureus biofilm-associated infections, and some patients may benefit from the combined treatment of ALA-PDT and antibiotics, but drug sensitivity testing should be performed in advance.

Hepatocyte Growth Factor Gene-Modified Mesenchymal Stem Cells Augment Sinonasal Wound Healing.

This study was designed to investigate the effects of hepatocyte growth factor (HGF) transgenic mesenchymal stem cells (HGF-MSCs) on wound healing in the sinonasal mucosa and nasal epithelial cells (NECs). We also sought to determine whether HGF-MSCs and MSCs can migrate into the injured mucosa and differentiate into ciliated cells. Human HGF-overexpressing umbilical cord MSCs (hHGF-UCMSCs) were established, and upregulation of hHGF expression was confirmed by real-time PCR (RT-PCR) and enzyme-linked immunosorbant assay (ELISA). To investigate the paracrine effect of human MSCs (hMSCs) on nasal epithelial repair, hMSC- and HGF-MSC-conditioned media (CM) were used in NEC proliferation assays and in an in vitro scratch-wound repair model. The in vivo sinonasal wound-healing model was established, and all enrolled rabbits were randomly assigned to four groups: the GFP-MSC group, the HGF-MSC group, the Ad-HGF group, and the surgery control group. The average decreased diameter was recorded, and the medial wall of the maxillary sinus was removed for histological analysis and scanning electron microscopy. Collagen deposition in the wound tissue was detected via Masson trichrome (M&T) staining. The distribution of MSCs and HGF-MSCs was observed by immunofluorescence. MSCs improved nasal wound healing both in vivo and in vitro. HGF overexpression in MSCs augmented the curative effects. Reduced collagen deposition and transforming growth factor beta1 (TGF-ß1) expression were detected in the HGF-MSC group compared with the MSC-, Ad-HGF-, and phosphate-buffered saline-treated groups based on M&T staining and ELISA. The enhanced therapeutic effects of HGF-MSCs were accompanied by decreased level of the fibrogenic cytokine TGF-ß1. In addition, both HGF-MSCs and MSCs can migrate to the injured mucosa and epithelial layer.

Comparison of chloromethyl-dialkylcarbocyanine and green fluorescent protein for labeling human umbilical mesenchymal stem cells.

To investigate the effectiveness of chloromethyl-dialkylcarbocyanine (CM-Dil) and green florescent protein (GFP) for tracking transplanted stem human umbilical cord-derived mesenchymal stem cells (hUC-MSCs), hUC-MSCs were labeled with CM-Dil or GFP and transplanted into guinea pigs with nasal mucosa radiation injury. In vitro and in vivo labeling efficiency was investigated by flow cytometry and fluorescence microscopy. Proliferation and multi-lineage differentiation potential of labeled hUC-MSCs were assessed via cell quantification and specific staining. In vitro CM-Dil and GFP labeling efficiency was 95 ± 12.2 and 90 ± 8 % at first passage, respectively. Labeled hUC-MSCs were detected by fluorescence microscopy 10 days (CM-Dil) or 20 days (GFP) after transplantation. Neither type of cell labeling affected the multi-differentiation potential but GFP labeling inhibited hUC-MSC proliferation due to virus toxicity. hUC-MSCs can be labeled with either CM-Dil or GFP with high efficiency without impacting multi-differentiation potential.

Human umbilical cord mesenchymal stem cells alleviate nasal mucosa radiation damage in a guinea pig model.

Nasal complications after radiotherapy severely affect the quality of life of nasopharyngeal carcinoma patients, and there is a compelling need to find novel therapies for nasal epithelial cell radiation damage. Therefore, we investigated the therapeutic effect of human umbilical cord mesenchymal stem cells (hUC-MSCs) in guinea pig model of nasal mucosa radiation damage and explored its therapeutic mechanism. Cultured hUC-MSCs were injected intravenously immediately after radiation in the nasal mucosa-radiation-damage guinea pig model. Migration of hUC-MSCs into the nasal mucosa and the potential for differentiation into nasal epithelial cells were evaluated by immunofluorescence. The therapeutic effects of hUC-MSCs were evaluated by mucus clearance time (MCT), degree of nasal mucosa edema, and the nasal mucosa cilia form and coverage ratio. Results indicate that the hUC-MSCs migrated to the nasal mucosa lamina propria and did not differentiate into nasal epithelial cells in this model. The MCT and degree of mucosal edema were improved at 1 week and 1 month after radiation, respectively, but no difference was found at 3 months and 6 months after radiation. The nasal mucosa cilia form and coverage ratio was not improved 6 months after radiation. Thus, hUC-MSCs can migrate to the nasal mucosa lamina propria and improve MCT and mucosa edema within a short time period, but these cells are unable to differentiate into nasal epithelial cells and improve nasal epithelial regeneration in the nasal mucosa radiation damage guinea pig model.

Extranodal sinonasal Rosai-Dorfman disease: a clinical study of 10 cases.

Sinonasal Rosai-Dorfman disease (S-RDD) is a rare form of RDD limited to the sinonasal cavity. Multipatient studies of Chinese S-RDD and documentation of its clinical spectrum are rare. This study aimed to identify the clinical profiles of Chinese S-RDD. Medical records of and tissue sections from 10 patients diagnosed with S-RDD between 2007 and 2014 were reviewed. Data on clinical presentations, endoscopy signs, imageological change, treatment and outcome were analyzed. The mean age of five male and five female patients at the first visit was 40.3 years and the mean follow-up period was 58.6 months. Based on the lesion sites, five cases were divided into an anterior sinonasal group, accompanied by symptoms of epistaxis, nasal obstruction and nasal dorsal deformity. Five other cases were divided into a posterior sinonasal group, accompanied by symptoms of hyposmia, epistaxis and nasal obstruction. Endoscopy signs and imageological changes in the anterior group showed diffuse infiltration of the RDD lesion under the septum mucosa, but in the posterior group the RDD lesions often showed as formations on polyps. At the end of follow-up, only one case spontaneously resolved without surgery; two cases in the anterior sinonasal group and three cases in the posterior sinonasal group recurred after endoscopic surgery, but surgery can result in short-term symptomatic control and restoration of function in all cases. S-RDD of the anterior and posterior sinonasal cavity may have different clinical characteristics; endoscopic surgery is effective for short-term symptomatic control and restoration of function for S-RDD.

Angiotensin-converting enzyme insertion/deletion polymorphism associated with allergic rhinitis susceptibility: evidence from 1410 subjects.

BACKGROUND AND OBJECTIVE: Whether the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene increases susceptibility to allergic rhinitis (AR) is still undetermined. Therefore, this meta-analysis was performed to systematically assess the possible association between them. METHODS: The OVID, Medline, Embase, Web of Science, CNKI and Wangfang databases were searched to identify the eligible studies focusing on the association between ACE I/D polymorphism and susceptibility to AR. RESULTS: A total of 1410 subjects from six studies were subjected to meta-analysis. In the overall analysis, ACE I/D polymorphism had a statistically significant association with increased AR risk under all genetic models (p<0.05). In the subgroup analysis by ethnicity, significant elevated AR risks were associated with ACE I/D polymorphism in Asians under all genetic models (p<0.05) and in Caucasians under under allele contrast, homozygous comparison and recessive models (p<0.05). In the subgroup analysis by age, ACE I/D polymorphism was associated with significant elevated risks of AR in adults (p<0.05) but not in children (p>0.05) under all genetic models. CONCLUSIONS: The ACE I/D polymorphism may be a risk factor for AR and studies with large sample size and representative population are warranted to verify this finding.

[Expression of B7-H1/PD-1 in mucosa of chronic rhinosinusitis].

OBJECTIVE: To explore the expression of B7-H1/PD-1 and the localization of these proteins in human sinus mucosa of chronic rhinosinusitis (CRS). METHODS: Twenty-eight patients with CRS (17 with nasal polyps (CRSwNP) and 11 without (CRSsNP)) and 11 control patients were recruited. B7-H1/PD-1 expressions in sinus mucosa among these 3 groups were detected by immunofluorescent staining, real-time quantitative PCR and Western blot. Flow cytometry was also employed to identify the type of B7-H1 or PD-1 positive cells in nasal polyps. RESULTS: Compared with normal mucosa, B7-H1/PD-1 mRNA was highly expressed in sinonasal mucosa of CRSwNP and CRSsNP (P < 0.01). There was no difference between CRSwNP and CRSsNP (P > 0.05). The protein level of B7-H1/PD-1 was similar to mRNA level. As indicated by immunofluorescent assay, B7-H1 was mainly expressed in sinonasal epithelial cells, submucosal gland cells and inflammatory cells within the subepithelial layer while PD-1 was expressed in inflammatory cells within the subepithelial layer. The B7-H1 or PD-1 positive cells in nasal polyps were partially CD19+ B cells and CD3+ T cells respectively. CONCLUSION: B7-H1/PD-1 is up-regulated in sinus mucosa of CRS. B7-H1/PD-1 may play an important role in the pathogenesis of CRS.

[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.

[Roles of epidermal growth factor receptor signaling pathway on cultured human nasal epithelial cells RPMI-2650].

OBJECTIVE: To explore the roles of epidermal growth factor receptor (EGFR) signaling pathway on cultured human nasal epithelial cells RPMI-2650. METHODS: RPMI-2650 cells were cultured in vitro, the growth curve was measured and the ultrastructure was observed using scanning electron microscope. When the cells were significantly confluent, they were divided into 4 groups, group A: maintained in Eagle's minimum essential media (EMEM) medium without adding any stimulators; group B: added with epidermal growth factor (EGF) 25 ng/ml; group C: added with AG1478 (EGFR selective inhibitor) 10 micromol/L followed by EGF 25 ng/ml 30 minutes later; group D: added with PD98069 (p44/42MAPK selective inhibitor) 30 micromol/L followed by EGF 25 ng/ml 30 minutes later. After incubated for 24 hours, the expression of EGFR and MUC5AC proteins in the cells of these 4 groups was studied using cytoimmunity and Western blotting. RESULTS: RPMI-2650 cells were significantly confluent after incubated for 5 to 7 days. The shape of cells was round or oval, and a large number of microvilli covered to their surface but without cilia under scanning electron microscope. The EGFR protein was expressed in the cells of group A and D, abundantly in group B, while weakly in group C. The values of comparative absorbance had significant difference between group A, B, D and group C, respectively (P < 0.01). For the MUC5AC protein, its expression was strong in the cells of group A, abundant in group B, and weak in group C and D. Significant difference of the values of comparative absorbance was analyzed between group B and group C, D, respectively (P < 0.01), while no difference between group C and group D (P > 0.05). CONCLUSIONS: The production of MUC5AC in human nasal epithelial cells RPMI-2650 is regulated via the expression and activation of epidermal growth factor receptor signaling pathway.

Endoscopic optic nerve decompression for the treatment of traumatic optic nerve neuropathy.

OBJECTIVE: We aimed to investigate the efficacy of endoscopic optic nerve decompression in patients with traumatic optic neuropathy. METHODS: We performed a retrospective analysis of 46 patients with traumatic optic neuropathy in the Shanghai Eye, Ear, Nose and Throat Hospital between March 2002 and September 2005. All patients were first treated with methylprednisolone for 6 days. Forty-four patients (46 eyes) that did not improve with methylprednisolone treatment were offered endoscopic optic nerve decompression. RESULTS: In 38 eyes with no light perception vision preoperatively, 21 eyes (45.6%) had improvement in visual acuity. These patients had postoperative light perception in 17 eyes, hand movement in 3 eyes and 60/200 in 1 eye. Four of 5 eyes with light perception preoperatively had postoperative vision for hand movement in 2 eyes, finger counting in 1 eye and 20/200 in 1 eye. For 3 eyes with preoperative visual acuity of hand movement, the postoperative visual acuities were 60/200, 60/200 and 120/200. Neither worsening of vision nor major complications was encountered in our series. CONCLUSIONS: We conclude that endoscopic optic nerve decompression in experienced surgeons' hands can improve visual acuity in traumatic optic nerve neuropathy with minimal morbidity. Our results also demonstrate that even patients initially without light perception may benefit from optic nerve decompression.

Up-regulation of the mucosal epidermal growth factor receptor gene in chronic rhinosinusitis and nasal polyposis.

OBJECTIVES: To investigate the expression of epidermal growth factor receptor (EGFR) messenger RNA (mRNA) in human sinus mucosa and to compare the expression of EGFR and EGF among patients with chronic rhinosinusitis (CRS), patients with CRS and nasal polyposis (CRS/NP), and a healthy control group. DESIGN: Maxillary sinus ostia mucosa was harvested from patients undergoing endoscopic sinus surgery for CRS or CRS/NP and from patients undergoing surgery for non-CRS pathologic conditions (control group). The samples were analyzed using semiquantitative reverse transcription-polymerase chain reaction to detect mRNA of EGFR. Hematoxylin-eosin staining and immunofluorescent staining were used to localize EGFR and EGF in the sinus mucosa. SETTING: Academic research. PARTICIPANTS: Three groups (CRS, CRS/NP, and control), each with 10 subjects, were enrolled in the present study. MAIN OUTCOME MEASURES: Area ratios of positive cells in the epithelia were compared among the CRS, CRS/NP, and control groups. In addition, eosinophils were counted in the subepithelial connective tissue in the 3 groups. RESULTS: The level of EGFR mRNAs in the sinus mucosa of the CRS and CRS/NP groups was statistically significantly increased compared with that in the control group (P < .01), and no statistically significant difference was found between the sinus mucosa of the CRS group and that of the CRS/NP group (P < .01). On hematoxylin-eosin staining, hyperplasia and metaplasia of epithelial goblet cells were present in the sinus mucosa of the CRS and CRS/NP groups. Epidermal growth factor receptor was mainly expressed in goblet cells and basal cells and was weakly expressed in ciliated cells, while EGF expression was located in epithelial cells and in some inflammatory cells but not in goblet cells. In the control group, expression of EGFR and EGF was lower compared with that in the CRS and CRS/NP groups. No statistically significant area ratios of positive cells differences in staining of EGFR and EGF were found between the CRS group and the CRS/NP group (P > .05), whereas statistically significant differences were found between the control group and the 2 CRS groups (P < .01). The number of eosinophils was statistically significantly increased in the CRS/NP group compared with that in the CRS group (P < .01). CONCLUSION: Up-regulation of the EGFR cascade may have an important role regarding mucus production in the sinus mucosa of patients with CRS and CRS/NP associated with hyperplasia and metaplasia of epithelial goblet cells.

The expression of MUC5AC and MUC5B mucin genes in the mucosa of chronic rhinosinusitis and nasal polyposis.

BACKGROUND: The aim of this study was to investigate the expression of MUC5AC and MUC5B messenger RNAs (mRNAs) and localization of these proteins in human sinus mucosa of chronic rhinosinusitis (CRS) and CRS with nasal polyposis (CRS/NP). METHODS: Maxillary sinus ostia mucosa was harvested from patients undergoing endoscopic sinus surgery for CRS, CRS/NP, and non-CRS pathologies (control). Then, sinus mucosa was analyzed using reverse-transcription polymerase chain reaction to detect mRNA of MUC5AC and MUC5B. Hematoxylin and eosin staining and immunofluorescent staining were used to localize MUC5AC and MUC5B proteins in the sinus mucosa. RESULTS: mRNAs of MUC5AC and MUC5B in the sinus mucosa of CRS and CRS/NP were significantly increased compared with that in normal sinus mucosa (p < 0.01), and no significant difference was found between the mucosa of CRS and that of CRS/NP (p > 0.05). MUC5AC protein was expressed mainly in the goblet cells, and MUC5B expression was located in the submucosal glands cells and the epithelia of sinus mucosa. ARPC in staining of MUC5AC and MUC5B were found no different between the CRS group and the CRS/NP group (p > 0.05), whereas they were significantly lower in the normal group compared with the other two groups, respectively (p < 0.05). CONCLUSION: This study showed that MUC5AC and MUC5B mucin genes were up-regulated in sinus mucosa of CRS and CRS/NP. MUC5AC and MUC5B may play an important role in the pathogenesis of CRS and NP.

[Management of sinonasal inverted papilloma: endoscopic excision vs traditional procedures].

OBJECTIVE: To evaluate the effect of endoscopic resection and traditional procedure in the management of sinonasal inverted papilloma with a staging system based on endoscopic examination of the nasal cavity and computed tomography (CT) scan evaluation. METHODS: Two hundred and twenty-two patients with sinonasal inverted papilloma treated surgically were retrospectively reviewed. There were 23 cases in stage I; 119 cases in stage II; 65 cases in stage III and 15 cases in stage IV. Among these patients, 122 cases were treated endoscopically; 100 cases were treated by traditional surgical techniques, including 56 cases with lateral rhinotomy; 27 cases with intranasal approach and 15 cases with Caldwell-Luc technique. RESULTS: The inverted papilloma was removed completely and no serious complications were encountered by all four kinds of techniques used. With an average follow-up of 3. 8 years, the recurrence rate for endoscopic group was 14.8% (18/122, four patients were in group I; nine in group II; four in group III; and one patient in group IV. No recurrence was found in group III who underwent endoscopic excision combined with Caldwell-Luc procedure. The recurrence rate for lateral rhinotomy group was 33. 9% (19/56, one patients in group I; six in group II; nine in group III; three in group IV). The recurrence rate for intranasal approach group was 51.9% (14/27, two patients were in group I; ten in group II; and two in group III). The recurrence rate for Caldwell-Luc procedure group was 29.4% (5/17, all in group II and group III). Regardless of approaches, patients who had primary resection had a recurrence of 26. 8%, whereas those with secondary resection had a recurrence of 20. 9% (P = 0.39). CONCLUSIONS: The endoscopic surgical technique was proved to be a better method for treating sinonasal inverted papilloma in stage I and stage II. Better results for patients in stage III would be achieved by combining endoscopic technique with Caldwell-Luc procedure. As to patients with stage IV, radical external approaches should be considered.

[Comparative study of the parameters related to type I thyroplasty measured by laryngeal specimens and computed tomography].

OBJECTIVE: To determine the consistence of the parameters related to type I thyroplasty measured by laryngeal specimens and CT scan. METHODS: The related parameters of 50 laryngeal specimens (unilateral) obtained following total laryngectomy were measured postoperative immediately, and compared with those measured by spiral CT scan with multiple plain reconstructive (MPR) technique preoperatively. Comparative results were analyzed to evaluate the statistical significance between these two methods. RESULTS: There were no significant statistical differences among the 6 parameters between two methods (P > 0.05), and the results (x +/- s) measured by CT scan and laryngeal specimens showed that the length of the thyroid notch to the inferior thyroid border were (20.7 +/- 1.7) mm and (20.6 +/- 1.7) mm; the length of the vocal cord were (17.3 +/- 1.8) mm and (17.3 +/- 1.8) mm; the length of the oblique line were (28.6 +/- 3.2) mm and (29.1 +/- 2.7) mm; the length of the presumptive horizontal line were (26.2 +/- 2.0) mm and (26.2 +/- 2.0) mm; the endolaryngeal vertical length of the anterior of the vocal cord to the presumptive horizontal line were (4.5 +/- 0.6) mm and (4.5 +/- 0.7) mm; the endolaryngeal vertical length of the vocal process to the presumptive horizontal line were (10.8 +/- 1.1) mm and (10.9 +/- 1.1) mm, respectively. As a result, the endolaryngeal anterior and posterior width of the wedge inserted in the thyroid cartilage were 4 - 5 mm and 8 - 9 mm respectively. CONCLUSIONS: MPR technique of spiral CT scan is able to design the size of the window and the prosthesis of type I thyroplasty preoperatively, which was testified to be a precise and reliable method to measure the larynx.