Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline for Chronic Rhinosinusitis

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines—with a focus on China—will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.

Chinese Society of Allergy Guidelines for Diagnosis and Treatment of Allergic Rhinitis

Allergic rhinitis (AR) is a global health problem that causes major illnesses and disabilities worldwide. Epidemiologic studies have demonstrated that the prevalence of AR has increased progressively over the last few decades in more developed countries and currently affects up to 40% of the population worldwide. Likewise, a rising trend of AR has also been observed over the last 2–3 decades in developing countries including China, with the prevalence of AR varying widely in these countries. A survey of self-reported AR over a 6-year period in the general Chinese adult population reported that the standardized prevalence of adult AR increased from 11.1% in 2005 to 17.6% in 2011. An increasing number of original articles and imporclinical trials on the epidemiology, pathophysiologic mechanisms, diagnosis, management and comorbidities of AR in Chinese subjects have been published in international peer-reviewed journals over the past 2 decades, and substantially added to our understanding of this disease as a global problem. Although guidelines for the diagnosis and treatment of AR in Chinese subjects have also been published, they have not been translated into English and therefore not generally accessible for reference to non-Chinese speaking international medical communities. Moreover, methods for the diagnosis and treatment of AR in China have not been standardized entirely and some patients are still treated according to regional preferences. Thus, the present guidelines have been developed by the Chinese Society of Allergy to be accessible to both national and international medical communities involved in the management of AR patients. These guidelines have been prepared in line with existing international guidelines to provide evidence-based recommendations for the diagnosis and management of AR in China.

A comparative study of endoscopic silicone tube intubation and conventional blind silicone tube intubation in the treatment of chronic dacryocystitis / 中国耳鼻咽喉头颈外科

OBJECTIVE To compare the costeffectiveness of two surgical approaches:endoscopic silicone tube intubation(ESTI) and conventional blind silicone tube intubation(CBSTI),in the management of chronic dacryocystitis(CDC).METHODS There were 46 cases of CDC from the Third Affiliated Hospital of Sun Yat-sen University from 2014 to 2015.Randomly,22 CDC patients were included in ESTI,24 patients were performed CBSTI.We analyzed both the final success rate,operating time,intraoperative visual analogue scale(VAS) and the rate of post-operative complications,as well as the final therapeutic effect.RESULTS In ESTI group,17 cases were cured,5 cases were improved and 3 cases were invalid.The success rate was 88.00％.Correspondingly for CBSTI group,14 cases were cured,6 eases were improved and 5 cases were invalid,and the success rate was 80.00％.ESTI was better,but there was no significant in success rate between the two groups (x2=0.881,P=0.644).Besides,the operating time and intraoperative VAS score in ESTI group was (10.32±2.30)min and 2.02±0.86,and they were(25.32 ± 4.87)min and 4.11 ± 1.44 in CBSTI group.So ESTI was better than CBSTI(t=-13.918,P=0.000;t=-6.012,P=0.000).ESTI had fewer complications(x2=4.878,P=0.027).CONCLUSION Compared to CBSTI,ESTI is a minimally invasive and highly effective technique for the treatment of CDC.The visualization of nasal endoscopy is the optimization of CBSTI,and this method need to be popularization and application.

Correlation of IL-19 and its receptors with tissue remodeling in chronic rhinosinusitis / 中国病理生理杂志

AIM:To explore the differential expression of interleukin-19 (IL-19) and its receptors (IL-20R1/IL-20R2) in the samples of chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP and CRSsNP), and to investigate the correlation of IL-19 and its receptors with tissue remodeling factors, including matrix metalloproteinase (MMP)-2, MMP-9 and tissue inhibitor of metalloproteinase (TIMP)-1 in CRS.METHODS:The polyps from CRSwNP patients (n=30), the sinus mucosa from CRSsNP patients (n=15) and the inferior turbinal mucosa of nasal septum de-viation patients (n=15) were collected.The expression of IL-19 and its receptors (IL-20R1/IL-20R2) in each group was detected by real-time RT-PCR and immunohistochemistry.The expression of tissue remodeling factors MMP-2, MMP-9 and TIMP-1 in different groups was detected by real-time RT-PCR and ELISA.RESULTS:Increased mRNA and protein expression levels of IL-19, IL-20R1, IL-20R2 and MMP-9 were observed in CRSwNP group compared with CRSsNP and control group (P<0.05), while elevated expression level of TIMP-1 was observed in CRSsNP group compared with CRSwNP and control group (P<0.05).The relative expression of MMP-2 among the 3 groups showed no obvious difference.The expression of IL-19 and its receptors showed significantly positive correlations with MMP-9 in CRSwNP (P<0.05).No significant correlation between IL-19 and/or its receptors with TIMP-1 in CRSwNP group was observed.CONCLUSION:The high expression levels of IL-19, IL-20R1 and IL-20R2 and their positive correlations with MMP-9 in CRSwNP indica-te that IL-19 and its receptors may be involved in the tissue remodeling of chronic rhinosinusitis.

Incidence of Otitis Media with Effusion in Adenoid Hypertrophy with Allergic Rhinitis in Children / 中山大学学报(医学科学版)

Objective]In order to study the impact of adenoid hypertrophy(AH)with allergic rhinitis(AR)in the otitis media with effusion(OME)in children,as well as to discuss the risk factors on the inducement of OME in patients with AH.[Methods]The clinical materials were collected and analyzed from 205 children with AH who admitted for surgical treatment between 2013 and 2015, including medical history and signs,acoustic immittance measurement,allergy screen as well as blood routine,and to evaluate the situation of OME and AR in patients with AH. All the data were analyzed by SPSS 20.0.[Results]Among the 205 AH children,66 cases(32.20%)were accompanying with OME. The AH patients aged 3-5 years had the highest incidence of OME,which decreased with age(P=0.018). It is significant on the prevalence of the OME in patients with AH between the two groups with and without AR (P = 0.010). In the logistic model investigating the risk factors of inducing OME among patients with AH,the third-degree AH, Type-three and the accompanying with AR were significant. The third-degree and third-type AH children were 2.729 and 6.390-folds higher than others respectively (P = 0.047,P = 0.001). The incidence of OME appeared to be 1.212-folds higher among patients with AR(P = 0.010).[Conclusion]Mechanical obstruction and AR played a superimposed role in the inducement of OME among patients with AH,which was effected by multiple factors. We should pay attention to the“lateral respiratory”allergic diseases on eustachian tube and middle ear.

Distribution and treatment onintractable epistaxis in concealed sites / 中国耳鼻咽喉头颈外科

OBJECTIVE To drew the map of distribution of concealed sites in epistaxis and optimize the mode of diagnosis and treatment. METHODS We have searched 117 references on intractable/refractory/latent epistaxis treated under nasal endoscopy in the last decade, including 11 708 cases with epistaxis. There were total 11 860 cases in this study plus 152 cases in our hospital. We summed up the experiences of the optimized treatment mode performed on concealed epistaxis, which was searching the accurate bleeding areas by nasal endoscopy and performing minimally invasive radiofrequency treatment without nasal packing. RESULTS We had found that the offending arteries about epistaxis are mainly sphenopalatine artery and anterior or posterior ethmoid artery. The frequency of bleeding areas came as follows: the vault of inferior nasal meatus in 3783 cases(31.90%), the olfactory sulcus of middle turbinate in 3522 cases(29.70%), the posterior regions of middle meatus in 1349 cases(11.37%), the regions of deviation of nasal septum in 1065 cases(8.98%), the foremost regions of nasal cavity in 738 cases(6.22%), and the others or uncertain in 1403 cases(11.83%). Finally, we drew a concise map of distribution about epistaxis on the basis of the concealed bleeding areas and offending vessels. 151 of 152 patients(99.34%) could find out the bleeding sites accurately and stop the bleeding through minimally invasive radiofrequency ablation. CONCLUSION We drew a map of distribution about epistaxis in concealed areas so that it is convenient for us to seek out the bleeding sites. Rational use of nasal endoscopy to explore the sites of intractable epistaxis and minimally invasive radiofrequency are optimized mode of treatment.

Clinical characteristics in patients with allergic rhinitis and nonallergic rhinitis in Guangzhou / 中国耳鼻咽喉头颈外科

OBJECTIVE To obtain and compare the clinical characteristics in patients with allergic rhinitis(AR) and nonallergic rhinitis(NAR) and investigate the trends in the proportion of AR and NAR in recent 10 years in Guangzhou. METHODS 5486 patients with nasal hyper-reactivity symptoms were divided into the AR group and NAR group. Clinical data including gender, age distribution and seasonality were analyzed. RESULTS The trends in the proportion of AR and NAR during the past decade did not change significantly. Male made up the majority of AR patients and NAR patients and AR patients were significantly younger than NAR patients. Male AR patients were significantly younger than females, while there were no significant difference in the age distribution among the male NAR patients and female ones. As the age increasing, the proportion of AR and NAR patients in overall study population present opposite tendency. The main onset season in AR was summer and in NAR was winter in Guangzhou city. CONCLUSION There were significant differences between AR and NAR in age, gender and seasonality. However, the trends in the proportion of AR and NAR in recent 10 years did not change significantly in Guangzhou.

The preparation of recombinant adenovirus Ad-Rad50-GFP and detection of the optimal multiplicity of infection in CNE1 transfected hv Ad-Rad50-GFP / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The optimal multiplicity of infection (MOI) of the recombinant adenovirus Ad-Rad50-GFP carrying a mutant Rad50 gene expression region on the cell growth of nasopharyngeal carcinoma and the viral amplification efficiency of CNE1 cell infected by this adenovirus were studied.@*METHOD@#The biological titer of Ad-Rad50-GFP was measured by end point dilution method. The impact of recombinant adenoviral vector transfection on the growth of CNE1 cells was observed by cell growth curve. Transfection efficacy of recombinant adenoviral vector was observed and calculated through fluorescence microscope. The expression f mutant Rad50 in the Ad-Rad50-GFP transfected CNE1 cells with optimal MOI was detected by Western Blot after transfection.@*RESULT@#The biological titer of Ad-Rad50-GFP was 1.26 x 10¹¹ pfu/ml. CNE1 cell growth was not influenced significantly as they were transfected by recombinant adenoviral vector with MOI less than 50. Transfection efficacy of recombinant adenoviral vector was most salient at 24 hours after transfection, with the high expression of mutant Rad50, and the efficiency still remained about 70% after 72 hours.@*CONCLUSION@#Recombinant adenoviral vector Ad-Rad50-GFP could transfect CNE1 cells as well as result in the expression of mutant Rad50 in CNE1 cells effectively. MOI = 50 was the optimal multiplicity of infection of CNE1 cells transfected by recombinant adenoviral vector Ad-Rad50-GFP.

Compliance to sublingual immunotherapy in patients with allergic rhinitis in Guangzhou city / 中国耳鼻咽喉头颈外科

ABSTRACT]OBJECTIVETo study the compliance to sublingual immunotherapy(SLIT) in patients with allergic rhinitis(AR) in Guangzhou city.METHODSFrom January 2014 to May 2014, 202 patients with AR received SLIT were followed up by telephone. According to age, the patients were divided into group A(age0.05). Main reasons for poor compliance included poor efficacy (48.48%), insufficient education about SLIT (16.67%), inconvenience (15.15%), and adverse reactions(10.61%).CONCLUSION In Guangzhou city, lost follow-up rate in AR patients receiving SLIT is high. Compliance to SLIT is relatively low and improvements shall be made.

Correlation of gammadelta-T-cells, Th17 cells and IL-17 in peripheral blood of patients with allergic rhinitis.

BACKGROUD: Gammadelta-T-cells play an important role in the mucosal immune system of the respiratory tract. Th17 cells plays an important role in promoting inflammation and autoimmune diseases. Th17 cells mainly secrete IL-17. However, little information is available on the relation between gammadelta-T-cells and Th17 cells in allergic rhinitis (AR). OBJECTIVE: To explore the correlation between the prevalence of gammadelta-T-cells, the prevalence of Th17 cells and the expression of IL-17 in the peripheral blood of patients with AR. METHODS: Peripheral blood from the AR group (32 cases) and the control group (20 cases) was collected from March 2012 to July 2012. The percentages of gammadelta-T-cells and Th17 cells were measured by flow cytometry, and the levels of IL-17 were measured by ELISA. RESULTS: The percentage of gammadeta-T-cells and Th17 cells in the AR group were significantly higher than those in the control group (P < 0.01). The levels of IL-17 in the AR group were also significantly higher than those in the control group (P < 0.01). There were positive correlations between the gammadelta-T-cell percentage and the Th17 cell percentage in the peripheral blood of AR patients (r = 0.597, P < 0.01); and between the gammadelta-T-cells percentage and the levels of IL-17 (r = 0.469,P < 0.01). However, no correlation was found between the Th17 cell percentage and the levels of IL-17 (r = 0.100, P > 0.05). CONCLUSION: Gammadelta-T-cells and Th17 cells may be involved in the pathogenesis of AR; gammadelta-T-cells may primarily be associated with the secretion of IL-17.

Application of enhanced CT in the differential diagnosis of peritonsillar abscess and intratonsillar abscess / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the application of enhanced CT in the differential diagnosis and treatment of peritonsillar abscess (PTA) and intratonsillar abscess (ITA).</p><p><b>METHODS</b>Thirty-eight in-patients with clinically suspected PTA from June 2011 to June 2013 were included in this study. All these patients underwent enhanced CT scan for the throat region. According to CT results, the location of abscess was determined, and the thickness of the posterior wall of abscess as well as its distance with the internal carotid artery was calculated.Incision and drainage were then guided with this information.</p><p><b>RESULTS</b>Twenty-six of the 38 patients (68.4%) met the diagnosis of PTA, demonstrating a hypodense collection with rim enhancement in the peritonsillar space, including 4 cases with multilocular abscess. Ten cases (26.3%) should actually be diagnosed as ITA, with a abscess collection located in the palatine tonsil tissue. Two cases(5.3%) were diagnosed as peritonsillar cellulitis (PTC), showing diffuse isodense lesion around the peritonsillar space. The 26 cases of PTA and 10 cases of ITA patients were all cured using incision and drainage under the precise guidance of CT, while the 2 cases of PTC only treated with medicine. The mean distance between the posterior wall of abscess and the carotid artery (X(-) ± s) were (0.76 ± 0.34) cm and (0.90 ± 0.37) cm for the two entities respectively, with no significant difference (P > 0.05).</p><p><b>CONCLUSIONS</b>Enhanced CT scan can clearly demonstrate the characters of PTA and ITA, and make identification. Moreover, it is helpful for the determination of therapy, improving the success rate of drainage and reducing the potential risk of large artery injury.</p>

Effects of tetrandrine on enhancing radiosensitivity of human nasopharyngeal carcinoma cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the effect and mechanism of tetrandrine (Tet) on enhancing radiosensitivity of human nasopharyngeal carcinoma cell lines in vitro.</p><p><b>METHODS</b>CNE1 and CNE2 were exposed to radiation with or without Tet, the DNA damage of the cells were evaluated by neutral comet electrophoresis, and cell cycle and apoptosis were analyzed by flow cytometry.</p><p><b>RESULTS</b>The mean tail movements (TM) of CNE1 treated with radiation or radiation plus Tet were (7.13 ± 3.70) (X(-) ± s) and (13.61 ± 5.45), respectively (t = 2.784, P < 0.05), and TM of CNE2 treated with radiation or radiation plus Tet were (11.52 ± 4.04) and (18.85 ± 6.18), respectively (t = 3.089, P < 0.05). With the exposure to radiation or radiation plus Tet, the percentages of CNE1 in G2 phases were (42.62 ± 2.07)% and (17.02 ± 1.87)%, respectively (t = 23.173, P < 0.01), and the percentages of CNE2 in G2 phases were (34.82 ± 2.74)% and (19.64 ± 4.82)%, respectively(t = 16.500, P < 0.01). There was no significant difference in the apoptosis rates between the cells treated with radiation or radiation plus Tet regardless of CNE1 (17.24 ± 0.99)% vs (19.11 ± 1.24)%, and CNE2 (16.68 ± 0.27)% vs (18.51 ± 2.41)% (P > 0.05).</p><p><b>CONCLUSIONS</b>Tet can enhance radiosensitivity of human nasopharyngeal carcinoma cell lines. The mechanism could be related to abrogation of radiation-induced G2/M arrest and reduction of double-strand break repair capacity.</p>

Effects of lentivirus-mediated epidermal growth factor-like domain 7 silencing on proliferation and invasion of human laryngeal carcinoma Hep-2 cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the effects of epidermal growth factor-like domain 7 (EGFL7) gene silencing on the proliferation and invasion ablity of laryngeal carcinoma cells.</p><p><b>METHODS</b>A lentiviral vector expressing EGFL7 shRNA was constructed and transfected into human laryngeal carcinoma Hep-2 cells. The expressions of EGFL7 mRNA and protein were detected by Real-time PCR and Western blot, respectively. Cell proliferation was evaluated by CCK-8 assay, cell cycle and apoptosis were tested by flow cytometry, and cell invasion was detected by transwell invasion assay.</p><p><b>RESULTS</b>The relative expression level s of EGFL7 mRNA and protein in EGFL7-SuRNA group were svgnificantly lower than control group (P < 0.001). Western blot analysis proved that the relative expression of EGFL7 protein in NC group, Lenti-NC group and Lenti-EGFL7 group was (0.39 ± 0.12),(0.36 ± 0.14) and (0.07 ± 0.04), respectively. EGFL7 expression in Lenri-EGFL7 group was significantly inhibited than NC group (P < 0.001), which confirmed that the recombinant lentivirus was successfully transfected into Hep-2 cells. The proliferation of Hep-2 cells was significantly inhibited after transfection (P < 0.01). Compared with the NC group and Lenti-NC group, the proportion of cells in S phase was significantly increased in Lenti-EGFL7 group (P < 0.01), and the proportion in G1 phase was significantly decreased (P < 0.05). Cell apoptosis assay showed that the apoptotic rate in Lenti-EGFL7 group (66.2 ± 1.28) % was significantly increased in NC group (6.09 ± 3.28) % and Lenti-NC group (9.86 ± 2.13) %. In Transwell invision assay, the mean number of cells coming through the Metrigel in Lenti-EGFL7 group was significantly decreased than in the NC group and Lenti-NC group (P < 0.01).</p><p><b>CONCLUSION</b>The proliferation and invasion ablity of laryngeal carcinoma Hep-2 cells can be inhibited by siRNA mediated EGFL7 gene silencing.</p>

Early genetic diagnosis in patients with HHT induced severe nosebleed / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the early gene diagnosis of hereditary hemorrhagic telangiectasia (HHT) induced severe nosebleed.@*METHOD@#Clinical features of 23 family members in two HHT pedigrees were examined. Genomic DNA was extracted from peripheral blood samples. PCR amplification was conducted to screen ENG and ACVRL-1 genes with their specific primers. Direct sequencing was performed to detect the mutation. Mutation analysis was carried out to evaluate its significance.@*RESULT@#A heterozygous c. 263A > G mutation was identified in exon 3 of ACVRL-1 in 6 out of 11 members in NMG-1 pedigree. In GD-2 pedigree, 5 of 11 members carried c. 199C > G mutation. Mutation detection rate was 100% in subjects with nosebleed history and 25% in family members without epistaxis.@*CONCLUSION@#Gene diagnosis characterized by high sensitivity and specificity is of great practi-cal significance and early genetic screening should be a clinical routine test for HHT induced severe nosebleed.

Proteomic analysis of plasma membrane from fluconazole-resistant Candida albicans / 中华皮肤科杂志

Objective To identify and analyze plasma membrane proteins differentially expressed between fluconazole-sensitive and-resistant C.albicans strains.Methods Two C.albicans strains from a same parent,including the fluconazole-sensitive C.albicans strain CA-3 and fluconazole-resistant C.albicans strain CA-16,served as the subject of this study.Plasma membrane proteins were isolated from both of the C.albicans strains,and subjected to two-dimensional polyacrylamide gel electrophoresis analysis for the screening of differentially expressed proteins,which were then identified by using matrix assisted laser desorption/ionization time-of-flight mass spectrometry.The resultant data were searched against a protein database for C.albicans.Results Twentytwo proteins were identified to be differentially expressed between the fiuconazole-resistant and-sensitive C.albicans strain.Of them,6 proteins (Adh1p,Csp37p,Pgk1p,Pgk1p and 2 unnamed proteins,i.e.,gi227305312and gi53954641) were highly expressed,while 16 proteins (Aco1p,Aco1p,Hsp78p,Gut2p,Sdh12p,Ilv2p,Ndh51p,Ndh51p,Atp1p,Pda1p,Srb1p,Idh1p,Tdh1p,Cyt1p,Cox4p,Cox13p) were lowly expressed in the fluconazole-resistant C.albicans strain compared with the fluconazole-sensitive strain.Conclusion The plasma membrane proteins differentially expressed between fluconazole-sensitive and-resistant C.albicans strain are mainly implicated in energy metabolism and mitochondrial function.

Differential proteomic analysis of fluconazole-sensitive Candida albicans before and after tetrandrine treatment / 中华皮肤科杂志

Objective To study the effects of tetrandrine on the protein expression profile of C. albicans,and to screen for proteins associated with the effect of tetrandrine. Methods Fluconazole-sensitive C. albicans CA-3 was cultured with or without tetrandrine (250 mg/L) for 6 hours followed by the collection of Candida cells. Total proteins were extracted from these cells and separated by using immobilized pH gradient two-dimensional polyacrylamide gel electrophoresis. Protein spots were detected and analyzed by Image Master 2D Platinum software, and MALDI-TOF/TOF-MS-based method was used to identify these proteins. Results The two-dimensional gel electrophoresis maps of C. albicans proteins before and after the treatment with tetrandrine were successfully obtained with high repeatability. Image analysis revealed a total of 26 differentially expressed protein spots in C. albicans treated with tetrandrine, and 7 differentially expressed proteins were identified by the mass chromatographic analysis, including 1 up-regulated protein (Pst1), and 6 down-regulated proteins (Idh1,Asc1, Rps5, Asn1, Asn1, Srb1 ). Conclusions The expressions of some proteins in fluconazole-sensitive C. albicans experience significant changes after tetrandrine treatment, and Pst1, Idh1, Asc1, Rps5, Asn1, Asn1 and Srb1 may considerab1y contribute to the effects of tetrandrine on C. albicans.

Clinical analysis of chronic rhinosinusitis in children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To determine the ideal treatment for the pediatric patients with chronic rhinosinusitis.@*METHOD@#Eighty-eight patients (aged 5-14 years) were divided into group A, B, C. In group A, 30 cases (60 sides) who had chronic rhinosinusitis without nasal polyps were treated systemically with medicine. In group B, 31 cases (62 sides) were chronic rhinosinusitis without nasal polyps and accompanied by adenoid vegetation and/or chronic tonsillitis,and were systemically treated with a combined therapy of medicine and adenoidectomy and/or tonsillectomy. In group C, 27 cases (54 sides) were chronic rhinosinusitis with nasal polyps,and were treated systemically with medicine and endoscopic sinus surgery.@*RESULT@#All patients were followed up for 12-18 months, with an average of 16 months. In group A, 48 sides were cured, 8 sides improved and 4 sides showed no effect. In group B, 46 sides were cured, 10 sides improved and 6 sides showed no effect. In group C, 40 sides were cured, 8 sides improved and 6 sides showed no effect. There were no significant differences in the efficacy among the three groups (P > 0.05).@*CONCLUSION@#Systemic medical treatment should be the first choice for chronic rhinosinusitis in children. Children with adenoid vegetation and/or chronic tonsillitis are basically treated with systemic medicine combined with adenoidectomy and/or tonsillectomy. Administration of medicine before and after the endoscopic surgery is more efficient for chronic rhinosinusitis with nasal polyps in children.

Analysis of factors affecting the pure tone threshold glycerol test / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To probe the factors that affect the pure-tone threshold glycerol test and the distribution of frequencies in positive glycerol test.@*METHOD@#We tested the pure-tone threshold before and after glycerol intake in patients with Meniere's disease, and then analyzed the positive rates,distribution of positive frequencies and the time when the maximum threshold changes appeared.@*RESULT@#The positive rate of pure-tone glycerol test was 72.09%, of which the threshold descending rate was 47.67%, and the threshold rebounding rate was 24.42%; the pure-tone threshold changes of descending group and rebounding group were (17.41 +/- 9.92) dB, (13.53 +/- 4.64) dB respectively, and the differences were significant. The distribution of positive frequencies were 250 Hz, 125 Hz, 500 Hz, 1 kHz, 4 kHz, 2 kHz, 8 kHz in descending order. The maximum pure-tone threshold changes mostly appeared within 2 or 3 hours after glycerol intake.@*CONCLUSIONS@#Patient selection, test occasion and the judgement criteria may affect the positive rate of glycerol test; the positive frequencies distribute in the low-frequency region mainly; the maximum pure-tone threshold changes mostly appeared within 2 or 3 hours after glycerol intake.

Improvement on primary culture of human nasal epithelium by enzymatical dissociation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To highlight the key points of primary culture of human nasal epithelial cells by enzymatical dissociation for high achievement ratio, and to establish a successful primary culture model for subsequent experiments.@*METHOD@#Primary culture of human nasal epithelial cells was performed with enzymatical dissociation of isolated tissue in serum--free medium. On the basis of this method, some improvements were subjected, such as stripping mucosal epithelium from adjacent connective tissue, applying DNase type I to digesting procedure, adding trypsin directly to the collagenase solution containing digested mucosa pieces, employing uncoated culture dishes and so on. Immunofluorescence with a monoclonal anti-cytokeratin antibody 8/18 was used to confirm the epithelial nature of the cultured cells.@*RESULT@#Nasal epithelial cells grew well and confluence on the 6th to 8th day. Positive expression of cytokeratin (CK) 8/18 showed the epithelial property of cultured cells.@*CONCLUSION@#Primary culture model of human nasal epithelial cells can be successfully established by enzymatical dissociation. Improvements on processes of material using and enzyme digestion can gain a high achievement ratio and harvest a high purity and certain amount of reliable primary epithelial cells.

Effect of clarithromycin on the expressions of cyclooxygenase-2 and nuclear factor-kappa B in nasal polyps in vitro / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To detect the expression and correlation of cyclooxygenase-2 (COX-2) and nuclear factor-kappa B (NF-kappaB) in nasal polyps co-cultured with clarithromycin, and to investigate their roles in CRS pathogenesis.@*METHOD@#Nasal polyps from 11 patients with chronic rhinosinusitis (CRS) were cultured for 24 hours with different doses of clarithromycin (0, 10(-6), 10(-5), 10(-4) mol/L). Western blot and real time fluorescence quantitative PCR were performed to detect the expressions of COX-2 and NF-kappaB subunits.@*RESULT@#The expression levels of COX-2, NF-kappaBp50 and NF-kappaBp65 were most high in control groups (0 mol/L clarithromycin). The expressions of COX-2, NF-kappaBp50 and NF-kappaBp65 were dose-dependently attenuated as the concentrations of clarithromycin increased. Significantly positive correlation between RNA expressions of COX-2 and NF-kappaB subunits in each CRS group was confirmed by Pearson correlation treatment (P<0.05).@*CONCLUSION@#The increased expression of COX-2 is involved in the inflammation in CRS. It indicate that clarithromycin may play an anti-inflammatory effect on CRS by decreasing the synthesis of COX-2 through blocking NF-kappaB pathway.