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1.
J Allergy Clin Immunol Pract ; 11(1): 43-50, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36610759

RESUMO

The field of chronic rhinosinusitis (CRS) is constantly evolving. In the past 10 years, key advancements in basic and translational research as well as clinical studies have improved our understanding and management of CRS. Notably, treatment options have expanded to include novel therapeutic drugs, devices, and surgical techniques. Assessments of patient symptoms and their impact on quality of life have become more standardized. Progress has also been made in both determining the true prevalence of CRS and recognizing comorbidities that can impact CRS severity. Practice guidelines have also shifted from expert opinion to more data-driven analyses. This review highlights major clinical advancements made in the field of CRS over the past 10 years as well as identifies current gaps in knowledge that can form the basis for new areas of study over the next decade.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Rinite/epidemiologia , Rinite/terapia , Rinite/diagnóstico , Qualidade de Vida , Pólipos Nasais/epidemiologia , Sinusite/diagnóstico , Sinusite/epidemiologia , Sinusite/terapia , Comorbidade , Doença Crônica
2.
Artigo em Chinês | MEDLINE | ID: mdl-36597363

RESUMO

Objective:To evaluate the efficacy of functional endoscopic sinus surgery(FESS) and radical endoscopic sinus surgery(RESS) in eosinophilic chronic sinusitis with nasal polyps(EosCRSwNP). Methods:A total of 44 patients diagnosed with EosCRSwNP in the Department of Otorhinolaryngology Head and Neck Surgery, Henan Provincial People's Hospital from July 1st, 2020 to August 1st, 2021 were included, the percentage of eosinophils in leukocytes in all patients included was more than 3.05%. The patients were randomly divided into FESS group and RESS group according to random number table. The visual analogue scale (VAS) score, Lund-Kennedy score and sino-nasal outcome test-22 (SNOT-22) were compared between the two groups before operation, 1 month, 3 months, 6 months and 1 year after operation. Results:At 1 year after operation, the scores of the two groups were significantly improved compared with those before operation, and the differences were statistically significant (P<0.01). There were significant differences in nasal endoscopic score, VAS score and SNOT-22 score between the two groups(P=0.01, P=0.03, P=0.03). The recurrence rate of RESS group was 26.09%(6/23) and that of FESS group was 61.90%(13/21), and the difference was statistically significant(P=0.04). Conclusion:Both RESS and FESS can improve nasal symptoms and promote olfactory recovery in EosCRSwNP patients, but RESS has more advantages in reducing recurrence and improving the prognosis of patients.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Pólipos Nasais/diagnóstico , Rinite/cirurgia , Rinite/diagnóstico , Sinusite/cirurgia , Sinusite/diagnóstico , Endoscopia , Olfato , Doença Crônica
3.
Medicina (Kaunas) ; 59(1)2023 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-36676746

RESUMO

Introduction: Chronic otitis media (COM) and chronic rhinosinusitis (CRS) are two of the most common otolaryngological disorders. CRS and COM share pathophysiological mechanisms such as bacterial infection, biofilm, and the persistence of the obstruction state of ventilation routes. The purpose of this systematic review was to evaluate all available information on the association between COM and CRS. Methods: The protocol of this investigation was registered on PROSPERO in November 2022. Pubmed, Scopus, Web of Science, and Cochrane databases were systematically searched according to the PRISMA statement. Results: After the application of inclusion-exclusion criteria, four manuscripts with adequate relevance to this topic were included in the review. The study population consisted of 20,867 patients with a diagnosis of CRS, of whom 991 were also diagnosed with COM (4.75%). Conclusions: The included studies have shown that CRS has become significantly associated with COMas: a global inflammatory process that involves the epithelium in both the middle ear and upper airway. The identification of a relationship between CRS and COM may contribute to preventing chronic inflammatory conditions through the early management of the associated disease. Further, carefully designed studies are necessary to demonstrate the relationship between COM and CRS.


Assuntos
Otite Média , Rinite , Sinusite , Humanos , Rinite/complicações , Sinusite/complicações , Otite Média/complicações , Otite Média/epidemiologia , Doença Crônica , Nariz
4.
Indian J Ophthalmol ; 71(1): 242-248, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36588244

RESUMO

Purpose: Orbital cellulitis is a serious condition with potentially severe complications. Treatment requires interdisciplinary care and early introduction of antimicrobial therapy. In our tertiary center, a team of pediatricians, pediatric ophthalmologists, and otorhinolaryngologists successfully participated in the management of pediatric periorbital/orbital cellulitis. This study aimed to demonstrate our interdisciplinary approach and to investigate clinical profile and management of pediatric periorbital/orbital cellulitis. Methods: A retrospective chart review was performed of all pediatric patients hospitalized for periorbital and orbital cellulitis in a tertiary hospital center from September 15, 2016, to March 15, 2020. Results: A total of 26 children-median age 2.7 years (range 0.5-12)-were treated during the study period. Disease presentation was unilateral, mainly during winter (n = 12) and autumn (n = 12), without ophthalmoplegia/proptosis. Seven patients had orbital cellulitis (Chandler classification of ≥III) and were older (6.5 years, P = 0.011) with sinusitis (P < 0.001), required surgery (P = 0.004), underwent longer antimicrobial treatment (13 days, P < 0.001), and had a longer length of hospital stay (13.43 days, P = 0.001). Orbital cellulitis occurred in a median of three days (range 1-12) of acute rhinosinusitis. Radiological survey was performed in 11 patients, whereas six patients were treated surgically. All intraoperatively collected cultures (sinus swabs) were positive, whereas Streptococcus pyogenes and Peptostreptococcus were isolated in five cases. All patients fully recovered. No recurrence was documented. Conclusion: Sinusitis is associated with severe orbital cellulitis and surgical management. Orbital cellulitis occurred early in the course of acute rhinosinusitis, as a distinctive presentation of rhinosinusitis. Interdisciplinary care and early management are crucial in treatment of pediatric periorbital/orbital cellulitis.


Assuntos
Exoftalmia , Oftalmopatias , Celulite Orbitária , Doenças Orbitárias , Sinusite , Criança , Humanos , Lactente , Pré-Escolar , Celulite Orbitária/diagnóstico , Celulite Orbitária/etiologia , Celulite Orbitária/terapia , Estudos Retrospectivos , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/terapia , Doença Aguda , Oftalmopatias/complicações , Antibacterianos/uso terapêutico , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/etiologia , Doenças Orbitárias/terapia
5.
PLoS One ; 18(1): e0279907, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36607911

RESUMO

OBJECTIVES: Paranasal sinus imaging due to chronic inflammatory disease is one of the most common examinations in head and neck radiology with CT imaging considered the current gold standard. In this phantom study we analyzed different low dose CT protocols in terms of image quality, radiation exposure and subjective evaluation in order to establish an optimized scanning protocol. METHODS: In a phantom study, an Alderson phantom was scanned using 12 protocols between 70-120 kV and 25-200 mAs with and without tin filtration. For all datasets, iterative reconstruction was used. Data were objectively evaluated (image noise, (dose-weighted) contrast-to-noise ratio) and for subjective evaluation an online survey using a Likert scale was performed to reach a large group of clinically experienced reader (n = 62). The protocol was considered diagnostically insufficient if the median score was 4 and above and if more than 10% of raters scored 4 and above on the Likert scale. For an interreader agreement an ICC was calculated. To compare clinical value in relation to the applied dose and the objective image parameters, we calculated a figure of merit (FOM) and ranked the protocols accordingly. RESULTS: There was an overall moderate agreement between the 62 readers for the 12 examined CT protocols. In this phantom study, protocols with 100 kV with spectral shaping and 50-100 mAs obtained the best results for its combination of dose, image quality and clinical information value for diagnosing sinusitis (FOM 1st- 2nd place) with the 70 kV and 50 mAs as a good alternative as well (Sinusitis: FOM shared 2nd). For preoperative planning, where a higher dose is necessary, 100 kV with spectral shaping and 100 mAs achieved the overall best results (FOM 1st place) with 70 kV and 50 mAs ranking 4th. CONCLUSION: 100-kV protocols with spectral shaping or low kV protocols (70 kV) with a similarly low dose showed the best figure of merit for imaging sinonasal disease and preoperative planning. With modern scanner technology available, spectral shaping or low KV protocols should be used for sinusitis imaging.


Assuntos
Sinusite , Estanho , Humanos , Doses de Radiação , Tomografia Computadorizada por Raios X/métodos , Intensificação de Imagem Radiográfica/métodos , Sinusite/diagnóstico por imagem , Imagens de Fantasmas
6.
Can Vet J ; 64(1): 76-80, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36593935

RESUMO

Sinusitis and pneumonia following exploratory celiotomy in horses were studied, evaluating associations between these 2 respiratory complications and selected pre-, peri-, and post-operative variables. The incidence of sinusitis was 2.5% (8/318) and pneumonia 3.5% (11/318). These respiratory complications were associated with peri-operative reflux, longer antimicrobial treatment, and longer hospitalization.


Sinusite et pneumonie postopératoires suite á une coeliotomie exploratoire pour le traitement des coliques chez le cheval. La sinusite et la pneumonie consécutives á une coeliotomie exploratoire chez le cheval ont été étudiées, afin d'évaluer les associations entre ces deux complications respiratoires et certaines variables pré-, péri- et postopératoires. L'incidence des sinusites était de 2,5 % (8/318) et des pneumonies de 3,5 % (11/318). Ces complications respiratoires étaient associées á un reflux périopératoire, á un traitement antimicrobien plus long et á une hospitalisation plus longue.(Traduit par Dr Serge Messier).


Assuntos
Cólica , Doenças dos Cavalos , Pneumonia , Sinusite , Cavalos , Animais , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/veterinária , Cólica/cirurgia , Cólica/veterinária , Laparotomia/veterinária , Pneumonia/veterinária , Sinusite/cirurgia , Sinusite/veterinária , Doenças dos Cavalos/cirurgia , Estudos Retrospectivos
7.
BMC Neurol ; 23(1): 25, 2023 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-36650509

RESUMO

BACKGROUND: Tolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia caused by idiopathic granulomatous inflammation involving the cavernous sinus region. Patients respond well to steroid therapy. THS is included in the differential diagnosis of cavernous sinus syndrome, so it is important to fully exclude other lesions in this area before treatment, otherwise steroid treatment may lead to fatal outcomes. Here we describe a patient who initially presented with symptoms that simulated THS symptoms and developed recurrent alternating painful ophthalmoplegia during follow-up, and the patient was finally diagnosed with cavernous sinusitis caused by bacterial sphenoid sinusitis. CASE PRESENTATION: A 34-year-old woman presented with left painful ophthalmoplegia. Magnetic resonance imaging (MRI) revealed abnormal signals in the left cavernous sinus area, and these abnormal signals were suspected to be THS. After steroid treatment, the patient obtained pain relief and had complete recovery of her ophthalmoplegia. However, right painful ophthalmoplegia appeared during the follow-up period. MRI showed obvious inflammatory signals in the right cavernous sinus and right sphenoid sinus. Then nasal sinus puncture and aspiration culture were performed, and the results showed a coagulase-negative staphylococcus infection. After antibiotic treatment with vancomycin, the painful ophthalmoplegia completely resolved, and the neurological examination and MRI returned to normal. CONCLUSION: Some other causes of painful ophthalmoplegia also fulfill the diagnostic criteria for THS in the International Classification of Headache Disorders third edition (ICHD-3) and respond well to steroid therapy. Early diagnosis of THS may be harmful to patients, and clinicians should exercise great caution when dealing with similar cases without a biopsy. Using "cavernous sinus syndrome" instead of "Tolosa-Hunt syndrome" as a diagnostic category may provide a better clinical thinking for etiological diagnosis.


Assuntos
Oftalmoplegia , Sinusite , Sinusite Esfenoidal , Humanos , Feminino , Adulto , Sinusite Esfenoidal/diagnóstico , Sinusite Esfenoidal/diagnóstico por imagem , Imageamento por Ressonância Magnética , Sinusite/complicações , Oftalmoplegia/diagnóstico , Esteroides/uso terapêutico
8.
Int J Mol Sci ; 24(1)2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36614203

RESUMO

Little is known about alternative treatment options for rhinosinusitis (RS). We aimed to evaluate the efficacy of low-level laser therapy (LLLT) for RS in experimentally induced rabbit models of RS. A total of 18 rabbits were divided into four groups: a negative control group (n = 3), an RS group without treatment (n = 5, positive control group), an RS group with natural recovery (n = 5, natural recovery group), and an RS group with laser irradiation (n = 5, laser-treated group). Computed tomography and histopathological staining were performed for each group. mRNA and protein expression levels of local cytokines (IFN-γ, IL-17, and IL-5) were also measured. Tissue inflammation revealed a significant improvement in the laser-treated group compared with the RS and natural recovery groups (p < 0.01). In addition, sinus opacification in the CT scans and cytokine expression was reduced in the laser-treated group, though without statistical significance. LLLT could be an effective option for the management of RS concerning radiological, histological, and molecular parameters.


Assuntos
Terapia com Luz de Baixa Intensidade , Rinite , Sinusite , Animais , Coelhos , Citocinas/genética , Citocinas/metabolismo , Terapia com Luz de Baixa Intensidade/métodos , Sinusite/metabolismo , Sinusite/terapia , Rinite/metabolismo , Rinite/terapia
9.
Medicina (Kaunas) ; 59(1)2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36676750

RESUMO

Background and Objectives: Chronic rhinosinusitis (CRS) is a common disease that can be differentiated into two phenotypes, with or without polyps (CRSwNP) or CRSsNP), which may be unilateral (UNIL) or bilateral (BIL). CRS may have an impact on absolute neutrophils and lymphocytes count in peripheral blood. The aim of the study was to investigate whether the incidence of a specific CRS phenotype changes with age and to compare the values of neutrophils, lymphocytes and neutrophil-to-lymphocyte ratio in the peripheral blood between groups of patients below and above 65 years of age with different CRS phenotypes. Material and Methods: A total of 235 patients aged 65 and over were examined, including 140 (59.6%) males. The group of patients <65 years of age comprised 160 subjects, including 103 (64.4%) males. In both groups, the sequence of frequency of particular phenotypes was similar: the most common phenotype was bilateral CRSwNP followed by CRSsNP BIL, CRSsNP UNIL, and finally, CRSwNP UNIL. Direct comparisons between determined phenotype in both groups of different ages revealed that, in the group ≥65 years, CRSwNP BIL occurred significantly more often than in the group <65 years of age. In fact, in the <65 group, bilateral CRSsNP was more common. The absolute neutrophils and lymphocytes counts were significantly higher in the whole group of patients with CRS ≥65 years of age and absolute number of neutrophils was higher in ≥65 years of age group with bilateral CRSsNP. Conclusions: The higher number of neutrophils in the whole ≥65 years of age group and in older patients with bilateral CRSsNP may indicate that CRS, despite of phenotype, may be an important source of infection that requires surgical treatment in elderly patients as well.


Assuntos
Rinite , Sinusite , Masculino , Feminino , Humanos , Rinite/complicações , Sinusite/complicações , Fenótipo , Linfócitos , Doença Crônica
10.
Am J Rhinol Allergy ; 37(1): 74-77, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36305039

RESUMO

BACKGROUND: The pathogenesis of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) remains still inconclusive. Recent studies identified an increased expression of BAFF (a B cell-activating factor) and its receptor TACI (Transmembrane Activator and cAML Interactor) in nasal polyp samples, while TNFRSF13B/TACI mutations have been found in patients with benign lymphoproliferative disorders and primary antibody deficiencies. OBJECTIVE: The aim of our study was to evaluate the possible contribution of TNFRSF13B/TACI mutations in CRSwNP pathogenesis. METHODS: Forty-four (44) patients with CRSwNP (male/female: 33/11, mean age: 52.5 years, range: 16-83) were analyzed for TNFRSF13B/TACI mutations by PCR-sequencing. RESULTS: No pathogenic TNFRSF13B/TACI mutations were identified in our cohort study of CRSwNP patients. We detected two common missense mutations (p.P251L and p.V220A), along with other common silent mutations and intronic polymorphisms in an identical prevalence to healthy control population. CONCLUSION: TNFRSF13B/TACI mutations might not play a role in the pathogenesis of CRSwNP.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Proteína Transmembrana Ativadora e Interagente do CAML , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Crônica , Estudos de Coortes , Mutação , Pólipos Nasais/genética , Rinite/genética , Sinusite/genética , Proteína Transmembrana Ativadora e Interagente do CAML/genética , Adolescente , Adulto Jovem , Adulto , Idoso , Idoso de 80 Anos ou mais
12.
Curr Opin Allergy Clin Immunol ; 23(1): 14-21, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36539379

RESUMO

PURPOSE OF REVIEW: Over the last years, extensive research has been done on neutrophils and their contribution in chronic rhinosinusitis (CRS), and made it clear that they are more than just a bystander in this disease. In this article, we will review all recent publications on this topic and look to what the future hold regarding therapeutics targeting the neutrophilic inflammation in CRS. RECENT FINDINGS: Evidence is growing that the presence of neutrophils are associated with a worse disease outcome in certain CRS patient groups. They are highly activated in type 2 inflammations and exhibit damaging properties through their proteases, contributing to the chronicity of the disease. Several recent studies identified useful biomarkers and targets for future therapeutics. SUMMARY: The findings we review in this manuscript are of utmost importance in unraveling the complexity of CRS and provide us with the necessary knowledge for future clinical practices.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Rinite/terapia , Inflamação/patologia , Sinusite/terapia , Doença Crônica , Neutrófilos/patologia , Pólipos Nasais/patologia
13.
Curr Opin Allergy Clin Immunol ; 23(1): 9-13, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36539378

RESUMO

PURPOSE OF REVIEW: Chronic rhinosinusitis with nasal polyps (CRSwNP) carries a high disease burden, and many studies have been done investigating the efficacy of various medical and surgical therapies. However, outcome metrics have varied across these studies, making it difficult to compare therapeutic efficacy on a large scale. In this article, we discuss various outcome metrics used across prior studies as well as the relationship between these measures. RECENT FINDINGS: Outcome metrics in CRSwNP studies include both clinically assessed and patient-reported outcome measures (PROMs). The former includes olfaction testing, scoring systems based on imaging and endoscopic evaluation, and histopathological and immunohistochemical evaluation of sinus tissue, and the latter includes quality-of-life instruments, symptom severity scales, and disease-control instruments. Recent studies evaluating the efficacy of new biologics have used a combination of both types of metrics. SUMMARY: Both clinical metrics and patient-reported outcomes provide utility in evaluating disease severity and control in patients with CRSwNP, although there are nuances when comparing therapies in this population as patients with CRSwNP are heterogeneous and may have symptoms across several domains. However, PROMs in conjunction with clinical metrics provide useful information to assess patient symptoms and response to interventions.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Rinite/terapia , Rinite/tratamento farmacológico , Pólipos Nasais/tratamento farmacológico , Sinusite/terapia , Sinusite/tratamento farmacológico , Doença Crônica
14.
Sci Rep ; 12(1): 21023, 2022 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-36470924

RESUMO

Odontogenic rhinosinusitis is a subtype of rhinosinusitis associated with dental infection or dental procedures and has special bacteriologic features. Previous research on the bacteriologic features of odontogenic rhinosinusitis has mainly used culture-dependent methods. The variation of microbiota between odontogenic and nonodontogenic rhinosinusitis as well as the interplay between the involved bacteria have not been explored. Therefore, we enrolled eight odontogenic rhinosinusitis cases and twenty nonodontogenic rhinosinusitis cases to analyze bacterial microbiota through 16S rRNA sequencing. Significant differences were revealed by the Shannon diversity index (Wilcoxon test p = 0.0003) and PERMANOVA test based on weighted UniFrac distance (Wilcoxon test p = 0.001) between odontogenic and nonodontogenic samples. Anaerobic bacteria such as Porphyromonas, Fusobacterium, and Prevotella were significantly dominant in the odontogenic rhinosinusitis group. Remarkably, a correlation between different bacteria was also revealed by Pearson's correlation. Staphylococcus was highly positively associated with Corynebacterium, whereas Fusobacterium was highly negatively correlated with Prophyromonas. According to our results, the microbiota in odontogenic rhinosinusitis, predominantly anaerobic bacteria, was significantly different from that in nonodontogenic rhinosinusitis, and the interplay between specific bacteria may a major cause of this subtype of rhinosinusitis.


Assuntos
Microbiota , Sinusite , Humanos , Disbiose/complicações , Disbiose/microbiologia , RNA Ribossômico 16S/genética , Bactérias Anaeróbias/genética , Sinusite/complicações , Sinusite/microbiologia , Bactérias/genética , Fusobacterium/genética
15.
Front Immunol ; 13: 1047930, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36466903

RESUMO

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common sinonasal inflammatory disorder with high heterogeneity. Increasing evidence have indicated that the infiltration of macrophages especially M2 macrophages play pivotal roles in the pathogenesis of CRSwNP, but the underlying mechanisms remain undetermined. This study sought to identify potential biomarkers related to M2 macrophages in CRSwNP. Methods: The expression datasets of GSE136825 and GSE179265 were download from Gene Expression Omnibus (GEO) database and merged. Then, CIBERSORT and weighted gene co-expression network analysis (WGCNA) algorithms were applied to identify M2 macrophage-related gene modules. Thereafter, differentially expressed genes (DEGs) related to M2 macrophages were selected to perform functional enrichment analyses. A protein-protein interaction (PPI) network was built to identify hub genes and quantitative real-time reverse transcriptions PCR was used to verify the bioinformatics results. Results: A total of 92 DEGs associated with M2 macrophages were identified for further analysis. The results of Gene ontology (GO) and Kyoto Encyclopedia of genes and genomes (KEGG) analyses illustrated that M2 macrophage-associated DEGs primarily enriched in immune responses and extracellular matrix structure. PPI network analysis identified 18 hub genes related to M2 macrophages that might be pivotal in the pathogenesis of CRSwNP. After verification, AIF1, C1QA, C1QB, C3AR1, CCR1, CD163, CD4, CD53, CD86, CSF1R, CYBB, FCER1G, FCGR3A, IL10RA, ITGB2, LAPTM5, PLEK, TYROBP were identified as potential M2 macrophage-related biomarkers for CRSwNP. Conclusion: These findings yield new insights into the hub genes and mechanisms related to M2 macrophages in the pathogenesis of CRSwNP. Further studies of these hub genes would help better understand the disease progression and identify potential treatment targets.


Assuntos
Pólipos Nasais , Sinusite , Humanos , Pólipos Nasais/genética , Sinusite/genética , Genes fms , Doença Crônica , Macrófagos
16.
PLoS One ; 17(12): e0278492, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36454862

RESUMO

This systematic review aims to assess the effects and safety of Chinese herbal medicines (CHMs) in the management of rhinosinusitis (RS); inform clinicians of the current state of the evidence; identify the best available evidence; and suggest further directions for research. Five English and four Chinese language databases, and four clinical trial registries were searched. Eligible studies were randomised controlled trials (RCTs). Participants were diagnosed with RS based on established criteria. Test interventions were CHMs administered orally and/or nasally, excluding injections and displacement techniques. Control interventions included placebos, no additional treatment, and conventional non-invasive treatments including pharmacotherapies and/or nasal irrigation, and/or inhalations. Polyposis and post-surgical recovery were excluded. Outcomes were Sino-Nasal Outcome Test (SNOT), visual analogue scales (VAS), Lund-Mackay computed tomography score (LM), Lund-Kennedy Endoscopic score (LK), Mucociliary transport time (MTT), Mucociliary transport rate (MTR), quality of life and adverse events (AEs). Risk of bias used the Cochrane tool. Meta-analysis in Review Manager 5.4.1 used random effects for mean difference (MD) or risk ratio (RR) with 95% confidence intervals. Heterogeneity was assessed as I2. Thirty-four RCTs were included, 30 of chronic RS (CRS) and four of acute RS (ARS). These enrolled 3,752 participants. Five RCTs blinded participants. For CRS, comparisons with placebo showed greater improvements in the CHM groups for SNOT-20 and VAS-TNS (total nasal symptoms). Blinded comparisons with pharmacotherapies showed no differences between groups in the degree of improvement for SNOT-20, VAS-TNS, and LM, suggesting these CHMs had similar effects, at least in the short term. In ARS, pooled results found improved scores on VAS-TNS and LK suggesting a benefit for combining these CHMs with pharmacotherapies. Limitations included inadequacies in study design and methodological reporting, and insufficient reporting of AEs. Heterogeneity in some pooled results precluded strong conclusions. Further well-designed studies are needed to test whether the results are replicable. Systematic review registration number: PROSPERO (CRD42019119586).


Assuntos
Sinusite , Humanos , Sinusite/tratamento farmacológico , Lavagem Nasal , Fitoterapia , China
17.
Artigo em Chinês | MEDLINE | ID: mdl-36543402

RESUMO

Objective:To analyze the expression of type Ⅱ inflammatory-related cytokines in nasal secretions of patients with eosinophilic chronic rhinosinusitis with nasal polyps(ECRSwNP), and to preliminarily explore the role of type Ⅱ inflammatory cytokines in nasal secretions in predicting ECRSwNP. Methods:A prospective analysis was made of 91 patients with CRSwNP who underwent endoscopic sinus surgery in Peking University Third Hospital from November 2020 to June 2021. All the selected patients had their SNOT-22 score, Lund-Mackay score and blood eosinophilia collected before surgery. Percentage and absolute value; the nasal secretions of patients were collected before operation, and enzyme-linked immunosorbent assay was used to detect the typeⅡinflammatory cytokines(IL-4, IL-5, IL-13, IL-25, IL-33, Eotaxin-3, periostin), intraoperative nasal polyp tissue was collected for eosinophil count. According to the proportion of eosinophils in the tissue≥10%, they were divided into ECRSwNP group and nECRSwNP group. The clinical baseline data and type Ⅱ inflammatory cytokines were compared between the two groups, and the related factors of ECRSwNP were evaluated by univariate logistic regression analysis. The receiver operating characteristic(ROC) curve was used to evaluate the predictive potential of each clinical index. Results:The SNOT-22 score, Lund-Mackay score, blood eosinophil percentage and absolute value in the ECRSwNP group were higher than those in the nECRSwNP group(P<0.05). In the nECRSwNP group(P<0.01). Logistic regression analysis found that IL-5, Eotaxin-3 and blood eosinophil percentage were risk factors for ECRSwNP(P<0.05). ROC analysis found that IL-5, Eotaxin-3 and blood eosinophil percentage had predictive diagnostic value(P<0.01), among which blood eosinophil percentage had the greatest predictive value(AUC=0.756). The prediction model composed of Eotaxin-3, SNOT-22 score, sinus CT Lund-Mackay score, blood eosinophil percentage and blood eosinophil absolute value had better prediction effect on ECRSwNP(AUC=0.873). Conclusion:Type Ⅱ inflammatory cytokines IL-5 and Eotaxin-3 in nasal secretions may be involved as biomarkers for early diagnosis of ECRSwNP.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Quimiocina CCL26 , Doença Crônica , Citocinas , Eosinófilos/metabolismo , Interleucina-5 , Pólipos Nasais/metabolismo , Rinite/metabolismo , Sinusite/metabolismo
18.
Eur Rev Med Pharmacol Sci ; 26(2 Suppl): 92-98, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36524916

RESUMO

Rhinosinusitis is one of the most common diseases today. Among diseases requiring treatment with antibiotics, it is the fifth most common. Acute rhinosinusitis is a significant medical problem that can significantly lower quality of life and can cause a large economic impact on society. Herein, we collected and analyzed data from several published studies regarding sinusitis with the aim of creating a sinusitis model. We included data from 786 studies published between 1996 and 2016 that came up on Google, Pro Quest Central or PubMed using the following keywords (or combinations thereof): "sinusitis", "rhinosinusitis", "experimental", "animal", "model", "rat", "rabbit", "guinea pig" and "mice". An appropriate sinusitis model must be established using the correct animal. Thus far, sinusitis models have been published in rats, mice, and rabbits, with rabbits being the most frequently used animal. These animals are used because the anatomy and physiology of their sinuses are very similar to those of humans. While these animals can be used in surgical models, it must be noted that prolonged stress can cause them high mortality rates. Several studies have used strains of Streptococcus pneumoniae to induce rhinosinusitis; however, it has recently been shown that other pathogenic agents can be used for this purpose as well. In this review, we presented several experimental sinusitis models in rats, mice, and rabbits. We hope that by presenting these methods, researchers may be better able to design and perform more useful sinusitis studies.


Assuntos
Rinite , Sinusite , Humanos , Coelhos , Camundongos , Ratos , Cobaias , Animais , Rinite/patologia , Consenso , Qualidade de Vida , Sinusite/patologia , Doença Aguda , Alérgenos , Doença Crônica
19.
Eur Rev Med Pharmacol Sci ; 26(2 Suppl): 15-24, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36524907

RESUMO

OBJECTIVE: The purpose of this study is to assess the effects of applying Garcinia cambogia to cultured human nasal epithelial cells. MATERIALS AND METHODS: A cell culture was set up consisting of human primary nasal epithelial cells harvested during septorhinoplasty from volunteers. The cells came from individuals with no history of rhinosinusitis. One assay for assessing cytotoxicity in cell culture utilizes MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide). This method allows visualization of fragmented DNA, condensation of nuclei and changes to the external cellular membrane or cytoskeleton. Our study employed this method. Nasal epithelial cells at 37°C were exposed in culture to G. cambogia for a period of 24 hours. Afterwards an MTT assay was used in conjunction with confocal microscopy to assess evidence of toxicity. The proliferative capability of the nasal epithelial cells was also evaluated by inducing a scratch injury to cultured cells followed by light microscopic examination. RESULTS: Testing for cytotoxicity in this manner indicates that G. cambogia does not appear harmful to cultured nasal epithelial cells when applied directly. The cells exposed to this plant extract were still fully viable 24 hours afterwards. There was no increase in viability at the level of statistical significance. It was noted, however, that proliferation did increase slightly within the exposure period. The MTT assay and confocal microscopy confirm these findings. Under confocal microscopic examination, a compact morphology with unaltered nuclear and cytoskeletal appearances was observed. Thus, there is no evidence suggesting viability is impaired or that cytotoxicity occurs. Ordinary light microscopic examination showed the area denuded of cells had become re-covered completely within 24 hours in the cultures where G. cambogia had been applied. The result suggests that exposure to G. cambogia has no significant effect in terms of stimulating or inhibiting cellular proliferation. CONCLUSIONS: G. cambogia may offer clinical benefit as a supplementary topical treatment for inflammation of the nose and sinuses, as seen in chronic and acute rhinosinusitis, or nasal polyps. The plant appears to increase nasal epitheliocytic proliferation slightly, as revealed by the MTT assay. There were no indications of a cytotoxic effect on epithelial cells of the nose.


Assuntos
Pólipos Nasais , Sinusite , Humanos , Garcinia cambogia , Células Cultivadas , Sinusite/tratamento farmacológico , Células Epiteliais
20.
Eur Rev Med Pharmacol Sci ; 26(2 Suppl): 124-133, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36524920

RESUMO

OBJECTIVE: Dexpanthenol is an ingredient in multiple topical pharmaceutical preparations thanks to its high penetration and localized concentration. It is included in many ointments or lotions for dermatological use, assisting in healing and reducing pruritus. Vaseline is a synthetic product obtained by distilling crude oil. It is commercially available in several grades. The study presented here examined how topically applied agents (dexpanthenol or vaseline) affect nasal epithelial cells in culture. In particular, the study aimed to identify any alterations to epithelial cells which might indicate toxicity. MATERIALS AND METHODS: The nasal epithelial cells used were sourced from mucosal tissue fragments left over the following septorhinoplasty on five patients not suffering from rhinosinusitis. The first step was to dissect the mucosal fragments into smaller pieces on a sterilized Petri dish. These fragments were then placed into the DMEM-F12 cell culture medium, which had been freshly prepared. The dexpanthenol and vaseline were diluted in dimethylsulfoxide (DMSO) to a concentration of 5 mg/mL. The cells in the wells were exposed to varying concentrations of dexpanthenol or vaseline. The actual concentration of the test reagent to which the epithelial cells were exposed ranged from 0.15 mg/mL to 5 mg/mL. The exposure period was 24 hours. The cells were finally examined using a Leica SP5II confocal microscope. The features sought were DNA fragmentation, condensation of the nuclei, changes in the outer membrane, or cytoskeletal abnormality. These features, if present, indicate cytotoxicity. RESULTS: The viability of the cultured nasal epithelial cells was unaltered by a 24-hour exposure to dexpanthenol, nor was the cellular proliferation rate affected at the level of statistical significance. There was evidence of a cytotoxic effect from exposing nasal epithelial cells to vaseline in liquid form for 24 hours. There was a reduction in cellular viability in the plates where the highest dose of vaseline (5 mg/mL) was used. Cellular viability was not affected significantly at any of the doses below 5 mg/mL. CONCLUSIONS: The absence of cytotoxic effects from the application of dexpanthenol to the nasal mucosa indicates that this agent may be safely used within the nose. The cytotoxic effects of liquid vaseline observed in this trial (condensed nuclear chromatin, loss of cellular volume) indicate that this agent may be harmful when used intranasally. For patients who require nasal packing due to nose bleeds or following endoscopic sinus surgical procedures, dexpanthenol should be preferred to vaseline from the point of view of maximizing healing of a nasal injury.


Assuntos
Excipientes , Sinusite , Humanos , Vaselina , Sinusite/cirurgia , Ácido Pantotênico/farmacologia
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