Impact of Nasal Cavity CT Opacification Upon Sinonasal Quality of Life.

BACKGROUND: Current methods of quantifying inflammation in chronic rhinosinusitis (CRS) on computed tomography (CT) imaging focus on opacification of the paranasal sinuses and show limited correlation with patient-reported outcome measures. OBJECTIVE: This study aimed to determine if quantifying CT opacification of the nasal cavity correlated with Sino-Nasal Outcomes Test scores (SNOT-22). METHODS: Thirty patients with CRS were enrolled. Lund-Mackay and SNOT-22 scores were measured. Nasal cavity regions of interest (ROIs) were measured by 2 independent raters using ImageJ at 3 points on coronal CT scans: anteriorly at the lacrimal duct, at the approximate midpoint demarcated by the posterior aspect of the globe, and posteriorly at the transition from the hard to soft palate. Superior and inferior regions were defined based upon the root of the inferior turbinate. Percent opacification was calculated for each ROI. Analyses were conducted bilaterally and for the side with greater opacification (worse side). RESULTS: Interrater reliability was strong for all ROIs. Lund-Mackay scores correlated with nasal blockage only (r = .495, P = .01) and did not correlate with nasal cavity ROI opacification. Inferior nasal cavity opacification for worse-sided anterior ROI and middle ROI correlated with SNOT-22 scores for nasal blockage (anterior r = .41, P = .03) (middle r = .42, P = .023) and runny nose (anterior r = .44, P = .02) (middle r = .38, P = .04). Posterior ROIs did not correlate with SNOT-22. CONCLUSIONS: Traditional CT scoring of sinus opacification does not correlate well with nasal cavity opacification or SNOT-22. Inferior nasal cavity inflammation provides unique correlations with SNOT-22 nasal questions and may guide targeted interventions in these regions.

Impact of Hedonics and Magnitude Upon Validated Psychophysical Olfactory Tests and Olfactory-Specific Quality of Life.

INTRODUCTION: Patients often describe the olfactory loss as either the inability to detect unpleasant odors (eg, smoke or spoiled food) or noticeable impairment in enjoying pleasant odors (eg, food and fragrances). This complex relationship between the hedonics of various odors, their perceived magnitude in odor strength, and the impact on patient quality of life is not well understood. METHODS: Sixty-five subjects underwent testing with the Henkin olfaction test which assesses hedonics and magnitude for odors traditionally deemed unpleasant (pyridine/dead fish and thiophene/gasoline) and pleasant (amyl acetate/banana and nitrobenzene/almond). Subjects also completed Smell Identification Test-40 (SIT-40), Sniffin' Sticks (Sniffin' Sticks), and Snap & Sniffin' Sticks (Snap) Olfactory Tests, as well as the 17-item Questionnaire for Olfactory Disorders Negative Statements (QODNS) and olfactory symptom visual analog scale (VAS). Spearman's rank correlations were conducted between various olfactory domains, QODNS and VAS. RESULTS: Mean age was 52.1 years (range: 28-86), with 63.1% females. Magnitude estimation was greatest for pyridine. Most people rated thiophene (75.4%) and pyridine (92.3%) as "unpleasant." Although most people rated amyl acetate (47.7%) and nitrobenzene (56.9%) as "pleasant," many rated amyl acetate (52.3%) and nitrobenzene (43.1%) as "neutral" or "unpleasant" scents. Hedonics for unpleasant odors correlated with each other (rs = 0.60), but not with hedonics for pleasant odors. Hedonics for unpleasant odors also correlated with magnitude estimation and other psychophysical tests. These findings were not seen for hedonics of pleasant odors. CONCLUSIONS: The use of unpleasant odors in Henkin testing showed unique relationship patterns with patient-reported outcome measures and validated olfactory tests, which may provide utility in characterizing olfactory dysfunction. The incorporation of more unpleasant odors in current psychophysical olfactory testing may provide enhanced information regarding the patient impact of olfactory dysfunction.

Inflammatory heterogeneity in aspirin-exacerbated respiratory disease.

BACKGROUND: Aspirin-exacerbated respiratory disease (AERD) is a mechanistically distinct subtype of chronic rhinosinusitis with nasal polyps (CRSwNP). Although frequently associated with type 2 inflammation, literature characterizing the milieu of inflammatory cytokines and lipid mediators in AERD has been conflicting. OBJECTIVE: We sought to identify differences in the upper airway inflammatory signature between CRSwNP and AERD and determine whether endotypic subtypes of AERD may exist. METHODS: Levels of 7 cytokines representative of type 1, type 2, and type 3 inflammation, and 21 lipid mediators were measured in nasal mucus from 109 patients with CRSwNP, 30 patients with AERD, and 64 non-CRS controls. Differences in inflammatory mediators were identified between groups, and patterns of inflammation among patients with AERD were determined by hierarchical cluster analysis. RESULTS: AERD could be distinguished from CRSwNP by profound elevations in IL-5, IL-6, IL-13, and IFN-γ; however, significant heterogeneity existed between patients. Hierarchical cluster analysis identified 3 inflammatory subendotypes of AERD characterized by (1) low inflammatory burden, (2) high type 2 cytokines, and (3) comparatively low type 2 cytokines and high levels of type 1 and type 3 cytokines. Several lipid mediators were associated with asthma and sinonasal disease severity; however, lipid mediators showed less variability than cytokines. CONCLUSIONS: AERD is associated with elevations in type 2 cytokines (IL-5 and IL-13) and the type 1 cytokine, IFN-γ. Among patients with AERD, the inflammatory signature is heterogeneous, supporting subendotypes of the disease. Variability in AERD immune signatures should be further clarified because this may predict clinical response to biologic medications that target type 2 inflammation.

Citizen science observations reveal rapid, multi-decadal ecosystem changes in eastern Long Island Sound.

Long-term environmental records are among the most valuable assets for understanding the trajectory and consequences of climate change. Here we report on a newly recovered time-series from Project Oceanology, a non-profit ocean science organization serving New England schools (USA) since 1972. As part of its educational mission, Project Oceanology has routinely and consistently recorded water temperature, pH, and oxygen as well as invertebrate and fish abundance in nearshore waters of the Thames River estuary in eastern Long Island Sound (LIS). We digitized these long-term records to test for decadal trends in abiotic and biotic variables including shifts in species abundance, richness, and diversity. Consistent with previous studies, the data revealed an above-average warming rate of eastern LIS waters over the past four decades (+0.45 °C decade-1), a non-linear acidification trend twice the global average (-0.04 pH units decade-1), and a notable decline in whole water-column dissolved oxygen concentrations (-0.29 mg L-1 decade-1). Trawl catches between 1997 and 2016 suggested a significant decrease in overall species diversity and richness, declines in cold-water adapted species such as American lobster (Homarus americanus), rock crab (Cancer irroratus), and winter flounder (Pseudopleuronectes americanus), but concurrent increases in the warm-water decapod Libinia emarginata (spider crab). Our study confirmed that Long Island Sound is a rapidly changing urban estuary, while demonstrating the value of long-term observations made by citizen-scientists, educators, and other stakeholders.

Biocompatible, biodegradable and porous liquid crystal elastomer scaffolds for spatial cell cultures.

Here we report on the modular synthesis and characterization of biodegradable, controlled porous, liquid crystal elastomers (LCE) and their use as three-dimensional cell culture scaffolds. The elastomers were prepared by cross-linking of star block-co-polymers with pendant cholesterol units resulting in the formation of smectic-A LCEs as determined by polarized optical microscopy, DSC, and X-ray diffraction. Scanning electron microscopy revealed the porosity of the as-prepared biocompatible LCEs, making them suitable as 3D cell culture scaffolds. Biodegradability studies in physiological buffers at varying pH show that these scaffolds are intact for about 11 weeks after which degradation sets in at an exponential rate. Initial results from cell culture studies indicate that these smectic LCEs are compatible with growth, survival, and expansion of cultured neuroblastomas and myoblasts when grown on the LCEs for extended time periods (about a month). These preliminary cell studies focused on characterizing the elastomer-based scaffolds' biocompatibility and the successful 3D incorporation as well as growth of cells in 60 to 150-µm thick elastomer sheets.