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1.
Artigo em Chinês | MEDLINE | ID: mdl-34979613

RESUMO

Objective:To explore the combination of sinus CT score and serum allergen sIgE to construct a postoperative recurrence risk model for patients with eosinophilic CRSwNP. Methods:The clinical data of 183 patients with eosinophilic CRSwNP who were treated in Luohe Central Hospital from January 2016 to January 2019 were collected. The curative effect was evaluated one year after the operation. According to the postoperative recurrence, they were divided into recurrence group and non-recurrence group. Single factor analysis of clinical and pathological factors on the postoperative curative effect of patients, XGboost model and multivariate Cox analysis of factors affecting postoperative recurrence. Draw the receiver operating characteristic(ROC) curves of the two models to compare the prediction effects of the XGboost model. The Kaplan-Meier method draws survival curve and compares the recurrence-free survival rate of patients with different risk levels. Results:The results of Cox multivariate analysis showed postoperative adherence to comprehensive treatment, tissue EOS ratio, tissue NEU ratio, tissue lymphocyte ratio, tissue plasma cell ratio, peripheral blood NEU ratio, Allergen sIgE and total sinus CT score were independent risk factors for recurrence. The top six factors influencing postoperative recurrence in the XGboost model were allergen sIgE, total sinus CT score, tissue EOS ratio, postoperative adherence to comprehensive treatment, tissue lymphocyte ratio, and tissue plasma cell ratio. The ROC curve showed that the area under the ROC curve of the XGboost model was 0.818. Cox analysis (0.789) with more factors increased by 3.68%, and the sensitivity, specificity and Youden index of the model were significantly higher than the multivariate Cox analysis model. The factors included in the XGboost model were used to construct a postoperative recurrence risk model. The recurrence-free survival rate of high-risk group was significantly lower than that of low-risk group and intermediate-risk group (log-rank test value:21.946, P<0.001). Conclusion:The postoperative recurrence risk model established by the sinus CT score combined with serum allergen sIgE can effectively predict the incidence of postoperative recurrence in patients. The XGboost model is better than the multivariate Cox analysis model in predicting postoperative recurrence in patients with eosinophilic CRSwNP. It can be used to predict postoperative recurrence.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Alérgenos , Doença Crônica , Eosinófilos , Humanos , Tomografia Computadorizada por Raios X
2.
Handb Exp Pharmacol ; 268: 151-170, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34085123

RESUMO

Chronic rhinosinusitis (CRS) is a clinical syndrome stemming from persistent inflammation of the sinonasal mucosa. Phenotypically, it is traditionally and widely described according to the presence or absence of polyps. While this distinction is simple to use, it has little bearing on prognosis and treatment, for CRS is essentially an inflammatory disease resulting from dysregulated interaction between a multitude of host and environmental factors. Allergy is merely one of them and, like many of the proposed aetiologies, has been subject to much debate which will be discussed here. As our understanding of CRS continues to evolve, previous so-called conventional wisdom about phenotypes (e.g. CRS with nasal polyps is associated with Type 2 inflammation) is being challenged, and new phenotypes are also emerging. In addition, there is growing interest in defining the endotypes of CRS to deliver precise and personalised treatment, especially pertaining to the development of biologics for the group of severe, difficult-to-treat CRS patients. A proposed model of precision medicine tailored to management of CRS will also be introduced to readers, which can be continually modified to adapt to new discoveries about this exciting condition.


Assuntos
Hipersensibilidade , Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Humanos , Pólipos Nasais/tratamento farmacológico , Medicina de Precisão , Rinite/diagnóstico , Rinite/tratamento farmacológico , Rinite/etiologia , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Sinusite/etiologia
3.
Am J Rhinol Allergy ; 36(1): 135-141, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34382434

RESUMO

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease with variable underlying pathophysiologies. Numerous patient factors have been linked to differences in disease severity, control, and response to treatment, including asthma status, aspirin sensitivity, previous sinonasal surgery, and blood eosinophil levels. OBJECTIVE: The present study examines the efficacy of the anti-immunoglobulin E therapy, omalizumab, versus placebo in patients with CRSwNP from the replicate POLYP 1 (NCT03280550) and POLYP 2 (NCT03280537) trials, grouped by inherent patient characteristics to determine the response to therapy. METHODS: Patients in prespecified subgroups from POLYP 1 and POLYP 2 (studies pooled for analysis) were examined. Subgroups included blood eosinophil count at baseline (>300 or ≤300 cells/µL), previous sinonasal surgery (yes or no), asthma status (yes or no), and aspirin sensitivity status (yes or no). Subgroups were examined for subgroup-specific adjusted mean difference (95% confidence interval [CI]) (omalizumab-placebo) in change from baseline at week 24 in Nasal Congestion Score (NCS), Nasal Polyp Score (NPS), Sino-Nasal Outcome Test-22 (SNOT-22), Total Nasal Symptom Score (TNSS), and University of Pennsylvania Smell Identification Test (UPSIT). RESULTS: Adjusted mean difference (95% CI) (omalizumab-placebo) in NCS, NPS, SNOT-22, TNSS, and UPSIT change from baseline at week 24 consistently favored omalizumab treatment over placebo in patients with blood eosinophil count >300 and ≤300 cells/µL, with or without previous sinonasal surgery, asthma, and aspirin sensitivity. CONCLUSION: Together, these data suggest broad efficacy of omalizumab across clinical and patient-reported outcomes in patients with CRSwNP, independent of the underlying patient factors examined, including those with high eosinophil levels and those who have undergone previous surgery, which are associated with high recurrence. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifiers: POLYP 1: ClinicalTrials.gov identifier NCT03280550 (https://clinicaltrials.gov/ct2/show/NCT03280550); POLYP 2: ClinicalTrials.gov identifier NCT03280537 (https://clinicaltrials.gov/ct2/show/NCT03280537).


Assuntos
Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Humanos , Pólipos Nasais/tratamento farmacológico , Omalizumab/uso terapêutico , Qualidade de Vida , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico
5.
Ann Otol Rhinol Laryngol ; 131(1): 5-11, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33834876

RESUMO

OBJECTIVES: There is a paucity of data on postoperative infections after endoscopic sinus surgery and associated risk factors. Our objective was to evaluate a cohort of patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis to determine which perioperative factors may be associated with infection in the 30-day postoperative period. METHODS: A retrospective cohort study of adults who underwent ESS at a tertiary academic medical center from 2015 to 2018 was performed. The primary outcome was incidence of postoperative infection, defined by identification of sinus purulence on nasal endoscopy necessitating antibiotics within 30 days of surgery. Independent variables collated included the result of postoperative cultures and use of perioperative antibiotics, oral corticosteroids, packing, and steroid-eluting stents. Statistical analysis involved bivariate analysis to identify variables that correlated with postoperative infection and subsequent multivariate logistic regression to identify independent risk factors. RESULTS: Three hundred seventy-eight unique ESS cases performed in 356 patients were reviewed. The mean age was 46 years (range, 18-87). The most common indication for surgery was chronic rhinosinusitis without nasal polyposis. The postoperative infection rate was 10.1%. The most commonly cultured pathogen was Staphylococcus aureus. Multivariate logistic regression analysis showed that postoperative systemic corticosteroid use was the only risk factor independently associated with infection (OR 3.47 [95% CI 1.23-9.76], P = .018). CONCLUSION: The incidence of postoperative infection following ESS was 10.1%. The use of postoperative systemic corticosteroids independently increased the risk of infection by 3.47-fold.


Assuntos
Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Endoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Rinite/cirurgia , Sinusite/cirurgia , Adulto , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Estudos Retrospectivos , Fatores de Risco
6.
Clin Imaging ; 81: 72-78, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34634577

RESUMO

Obliterative paranasal sinusitis is a rare sequela and end stage of chronic rhinosinusitis, which is often overlooked on imaging. It is an exuberant form of neo-osteogenesis characterized by complete or partial obliteration of the sinus cavity by new bone formation. This article presents a series of cases of obliterative sinusitis involving the sphenoid and maxillary sinuses. It is important to comment on the presence of obliterative sinusitis in the radiology report and not confuse it for native bone, fibro-osseous lesion, or arrested pneumatization, as this may have clinical implications for patients being considered for surgery. Given its potential implications for severity of sinusitis as well as prognostic significance for outcomes following endoscopic sinus surgery, awareness and timely identification of this entity is important to guide referring clinicians.


Assuntos
Sinusite , Tomografia Computadorizada por Raios X , Doença Crônica , Endoscopia , Humanos , Seio Maxilar , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Osso Esfenoide
7.
Clin Imaging ; 81: 103-106, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34695722

RESUMO

Acute bacterial sinusitis may be complicated by orbital and intracranial involvement and by thrombophlebitis. Its spread across multiple anatomic compartments is facilitated by the interconnected venous anatomy of the head and neck and the virulence of the primary pathogen. We present a rare case of Streptococcus Intermedius (S. Intermedius) acute bacterial sinusitis complicated by extensive skull base involvement including cavernous sinuses and neck vein thrombophlebitis and thrombosis.


Assuntos
Sinusite , Sinusite Esfenoidal , Tromboflebite , Humanos , Base do Crânio/diagnóstico por imagem , Streptococcus intermedius
8.
Talanta ; 237: 122972, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34736695

RESUMO

Sulfur dioxide (SO2) plays an extremely important role in the basic processes of physiology and pathology. As an antioxidant, SO2 can maintain the redox homeostasis in the cell. Excessive inhalation of SO2 would lead to irreparable respiratory damage, resulting in respiratory diseases, neurological disorders, and even cardiovascular disease. Thus, it is urgent to exploit an excellent way to monitor SO2 derivatives in biological system. Herein, we design a water-soluble ratiometric fluorescent probe to fast detect the level of SO2 derivatives in living cells in vivo. The probe displays obvious fluorescence signal at long wavelength, which is helpful for imaging of biological system. After respond to SO2 derivatives, the fluorescence signal at 465 nm increases rapidly due to the Michael addition reaction is triggered, further causing the disruption of large conjugated system. The probe exhibits high selectivity and fast respond to SO2 derivatives, which can be able to sensitive and real-time monitoring of SO2 derivatives level in living cells. Moreover, the probe reveals a low detection limit and a great linear relationship to SO2 derivatives. Based on the negligible cytotoxicity and good biocompatibility of the probe, which is employed to detect exogenous and endogenous SO2 derivatives in living cells. In addition, it is also served as a potential chemical tool to detect SO2 derivatives in mice model of sinusitis.


Assuntos
Corantes Fluorescentes , Sinusite , Animais , Fluorescência , Células HeLa , Humanos , Camundongos , Dióxido de Enxofre/toxicidade , Água
9.
Am J Rhinol Allergy ; 36(1): 33-40, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33910378

RESUMO

BACKGROUND: Currently, no consensus exists on the appropriate control specimen site to utilize in studies evaluating for biomarkers in chronic rhinosinusitis (CRS). Studies thus far have utilized tissue from various anatomic sites despite regional heterogeneity. OBJECTIVE: We set out to quantify the differences in biomarker levels present in inferior turbinate versus sphenoid sinus mucosa in paired healthy control patients. We hypothesize that statistically significant differences in cytokine/chemokine expression exist between these two distinct sites. METHODS: A 38-plex commercially available cytokine/chemokine Luminex Assay was performed on 54 specimens encompassing paired inferior turbinate and sphenoid sinus mucosa samples from 27 patients undergoing endoscopic anterior skull base surgery. Patients with a history of CRS were excluded. Paired sample t-tests and Fisher's exact tests were performed. RESULTS: Twenty-seven patients were included in the study, including 10 male and 17 female patients with an average age of 48 years. The following 8 biomarkers had statistically significant concentration differences between inferior turbinate mucosa and sphenoid mucosa sites: Flt-3L, Fractalkine, IL-12p40, IL-1Ra, IP-10, MCP-1, MIP-1ß, and VEGF, with all P-values <0.01. CONCLUSION: No consensus exists regarding the optimal choice of control specimen for CRS research. We present statistically significant quantitative differences in biomarker levels between paired inferior turbinate and sphenoid mucosa samples. This confirms the presence of heterogeneity between different subsites of sinonasal mucosa and highlights the need for standardization in future CRS research.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Biomarcadores , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/patologia , Pólipos Nasais/patologia , Rinite/diagnóstico , Rinite/patologia , Sinusite/diagnóstico , Sinusite/patologia , Conchas Nasais/patologia , Conchas Nasais/cirurgia
10.
Am J Rhinol Allergy ; 36(1): 72-80, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34096329

RESUMO

BACKGROUND: Biologic therapies such as mepolizumab and benralizumab are currently utilised in the treatment of eosinophilic asthma, and are emerging in the management of eosinophilic chronic rhinosinusitis (eCRS). These biologics inhibit the interaction of IL-5 with its receptor, thus impairing cytokine signalling and eosinophil inflammation. Mepolizumab does so by targeting IL-5, whereas benralizumab targets the α chain of the IL-5 receptor. This study compares the sinonasal tissue response to anti-IL-5 biologic therapies in patients with eCRS. METHODS: A cross-sectional study of adult eCRS patients who had completed at least 2 cycles of biologic therapy and underwent endoscopic sinus surgery as part of their management were included. Sinonasal mucosal tissue biopsies were obtained intraoperatively and assessed with structured histopathological examination. Comparisons of tissue histopathology outcomes following treatment with mepolizumab or benralizumab were performed. RESULTS: 18 patients (age 49.6 ± 14.2 years, 47% female, 100% co-morbid asthma) were included in this study, comprising 10 patients managed with mepolizumab and 8 patients managed with benralizumab. Even after mepolizumab, the tissue had predominantly eosinophilic inflammation compared to benralizumab (90% v 0%, p < 0.01), which demonstrated a greater lymphoplasmacytic inflammation (10% v 75%, χ2(2) = 14.53, p < 0.01). Compared with benralizumab, mepolizumab had increased tissue eosinophil count (100% v 37.5% >10 eosinophils/HPF, τb = -8.47, p < 0.001) and more severe subepithelial oedema (80% v 37.5% severe, τb = -2.37, p = 0.02). CONCLUSION: Tissue histopathologic outcomes reflect the differing mechanism of action of mepolizumab and benralizumab in eCRS. Further analysis at the tissue level will provide further information to guide application of mAbs in type 2 inflammatory diseases.


Assuntos
Antiasmáticos , Asma , Sinusite , Adulto , Antiasmáticos/uso terapêutico , Estudos Transversais , Eosinófilos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sinusite/tratamento farmacológico
11.
Am J Rhinol Allergy ; 36(1): 115-122, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34232770

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused a global pandemic. Higher expression of the virus receptor angiotensin-converting enzyme 2 (ACE2) in the nasal mucosa may be associated with high transmissibility and asymptomatic infection. In COVID-19, the elucidation of the determinants of ACE2 expression at nasal tissue level is crucial. The development of strategies to downregulate ACE2 expression in nasal epithelial cells might reduce transmission and be useful as a novel therapeutic approach. OBJECTIVE: To verify ACE2 expression in the nasal mucosa of patients with seasonal allergic rhinitis induced by Japanese cedar pollen (SAR-JCP) and chronic rhinosinusitis with nasal polyp (CRSwNP) and to examine the effects of short-chain fatty acids (SCFAs) on ACE2 expression in airway epithelial cells. METHODS: We assessed ACE2 expression in the nasal mucosa of control subjects, patients with SAR-JCP, and those with CRSwNP using real-time polymerase chain reaction. We also quantified ACE2 gene expression in cultured airway epithelial cells. RESULTS: Although ACE2 expression was greatly increased in a few patients with SAR-JCP during the Japanese cedar pollen season, mean levels were not significantly increased. ACE2 mRNA expression was significantly decreased in nasal polyp tissue from patients with chronic rhinosinusitis compared with the expression in that from control subjects. SCFAs generated by gastrointestinal microbiota significantly reduced resting ACE2 expression in cultured airway epithelial cells. SCFAs also significantly suppressed the dsRNA-dependent upregulation of ACE2 expression in airway epithelial cells. CONCLUSION: Inflammatory endotype affects ACE2 expression in the nasal mucosa and influences susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In particular, type 2 inflammation could downregulate ACE2 expression in the nasal mucosa and reduces susceptibility to SARS-CoV-2 in patients with CRSwNP. Although in vivo experiments are required, administration of SCFAs to the nasal cavity might be worthy of consideration as a preventative or therapeutic strategy for the early-stage COVID-19.


Assuntos
COVID-19 , Sinusite , Enzima de Conversão de Angiotensina 2 , Humanos , Mucosa Nasal , SARS-CoV-2
12.
Curr Opin Otolaryngol Head Neck Surg ; 30(1): 58-62, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34958322

RESUMO

PURPOSE OF REVIEW: The etiologic role of fungi in chronic rhinosinusitis remains controversial. The purpose of this review is to further our understanding of molecular immunologic pathways activated by fungi and clinical trials of antifungals in severe subtypes of asthma and allergic fungal rhinosinusitis. RECENT FINDINGS: Various fungal components such as protease and chitin are capable of eliciting a type 2 innate and adaptive immune response. However, definitive studies on the etiologic role of fungi in chronic rhinosinusitis (CRS) is dependent on the development of a fungi-induced murine model of CRS. Short of this model, extrapolations of observations and results from clinical trials in fungi-induced asthma subtypes support a key role of fungi in the pathophysiology of allergic fungal rhinosinusitis and possibly other CRS endotypes. SUMMARY: Fungi plays a key role in the pathophysiology of several subtypes of chronic inflammatory respiratory diseases. However, a fungi-induced murine model of CRS is needed to explicitly investigate the molecular pathways and potential therapeutic targets.


Assuntos
Asma , Rinite , Sinusite , Animais , Doença Crônica , Fungos , Humanos , Camundongos
13.
Curr Opin Otolaryngol Head Neck Surg ; 30(1): 63-67, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34958323

RESUMO

PURPOSE OF REVIEW: Although the majority of patients with sinus headache do not have rhinosinusitis, many patients will unnecessarily undergo work-up and treatment for rhinosinusitis. This leads to a significant cost burden to the healthcare system. In the era of value-based care, more effective management paradigms need to be developed for sinus headache. RECENT FINDINGS: Recent efforts to classify nonrhinogenic headache, namely the International Classification of Orofacial Pain, have served as an important step in advancing our understanding of this heterogeneous condition. In addition, a review of the literature points to certain clinical features that may allow for the identification of nonrhinogenic headache based on history. SUMMARY: A greater understanding of nonrhinogenic headache as well as innovative tools to differentiate rhinogenic from nonrhinogenic headache are needed to change the paradigm in the management of patients with sinus headache.


Assuntos
Cefaleia , Sinusite , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Sinusite/diagnóstico , Sinusite/terapia
14.
Curr Opin Otolaryngol Head Neck Surg ; 30(1): 68-77, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34958324

RESUMO

PURPOSE OF REVIEW: Review the diagnosis and management of pediatric chronic sinusitis given recent advances in both surgical and medical management. RECENT FINDINGS: Balloon catheter dilation (BCD) of the sinuses has been used as an adjunct to adenoidectomy or in lieu of traditional endoscopic sinus surgery. BCD has been shown to be a safe technique in children although its efficacy compared to maxillary sinus irrigation or traditional sinus surgery cannot be determined based on current studies. SUMMARY: New advances in BCD and biologics may serve as useful adjuncts in surgical and medical therapy respectively with additional research needed to better delineate the optimal indications for each in the treatment continuum.


Assuntos
Rinite , Sinusite , Criança , Doença Crônica , Dilatação , Endoscopia , Humanos , Seio Maxilar , Sinusite/diagnóstico , Sinusite/terapia
15.
PLoS One ; 16(12): e0261179, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34962959

RESUMO

BACKGROUND: Distinct bacterial upper airway microbiota structures have been described in pediatric populations, and relate to risk of respiratory viral infection and, exacerbations of asthma. We hypothesized that distinct nasopharyngeal (NP) microbiota structures exist in pediatric populations, relate to environmental exposures and modify risk of acute sinusitis or upper respiratory infection (URI) in children. METHODS: Bacterial 16S rRNA profiles from nasopharyngeal swabs (n = 354) collected longitudinally over a one-year period from 58 children, aged four to seven years, were analyzed and correlated with environmental variables, URI, and sinusitis outcomes. RESULTS: Variance in nasopharyngeal microbiota composition significantly related to clinical outcomes, participant characteristics and environmental exposures including dominant bacterial genus, season, daycare attendance and tobacco exposure. Four distinct nasopharyngeal microbiota structures (Cluster I-IV) were evident and differed with respect to URI and sinusitis outcomes. These clusters were characteristically either dominated by Moraxella with sparse underlying taxa (Cluster I), comprised of a non-dominated, diverse microbiota (Cluster II), dominated by Alloiococcus/Corynebacterium (Cluster III), or by Haemophilus (Cluster IV). Cluster I was associated with increased risk of URI and sinusitis (RR = 1.18, p = 0.046; RR = 1.25, p = 0.009, respectively) in the population studied. CONCLUSION: In a pediatric population, URI and sinusitis associate with the presence of Moraxella-dominated NP microbiota.


Assuntos
Microbiota , Moraxella/fisiologia , Infecções por Moraxellaceae/microbiologia , Nasofaringe/microbiologia , Infecções Respiratórias/microbiologia , Sinusite/microbiologia , Criança , Pré-Escolar , Contagem de Colônia Microbiana , Meio Ambiente , Feminino , Humanos , Masculino , Filogenia , Análise de Componente Principal
17.
Vestn Otorinolaringol ; 86(6): 105-112, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34964339

RESUMO

The review presents the current understanding of the pathogenesis of chronic rhinosinusitis. The causes of damage to the mucous membrane of the paranasal sinuses are most often the result of a combination of immunological, infectious and anatomical factors. This indicates the need for a multidisciplinary approach to the study of the pathogenesis of this pathology. There is no single universally recognized classification of chronic rhinosinusitis, which takes into account histological and immunological changes in the mucous membrane of the paranasal sinuses. The discovery of the mechanism of completion of the life cycle of neutrophils - the formation of a neutrophil extracellular trap or NETosis, different from necrosis and apoptosis, opened up new prospects in the study of the pathogenesis of inflammatory processes, including rhinosinusitis. Neutrophil extracellular traps reduce the permeability of the epithelial barrier in the mucous membrane of the paranasal sinuses. This determines their possible role in the etiopathogenesis of rhinosinusitis. In recent years, more and more attention has been paid to the feasibility, effectiveness and safety of therapy that affects the immune component of the inflammatory process, including NETosis. The data obtained in the study of extracellular traps can be used in clinical practice. It is neutrophil extracellular traps that can become a potential target in the treatment of patients with chronic rhinosinusitis.


Assuntos
Armadilhas Extracelulares , Sinusite , Doença Crônica , Humanos , Membrana Mucosa , Neutrófilos , Sinusite/etiologia
18.
Arerugi ; 70(10): 1376-1382, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34911890

RESUMO

OBJECTIVE: To ensure that the best possible information is available for selecting treatment options in patients who have chronic rhinosinusitis with nasal polyps (CRSwNP), it is necessary to assess experiences with surgical procedures in real-world clinical practice. METHODS: We used an internet questionnaire to survey 300 patients who had a history of CRSwNP surgery or had been recommended for such surgery. RESULTS: The patients who underwent surgery showed high satisfaction with the effectiveness of the surgery. However between 20% and 30% were notably dissatisfied with the safety of the procedure, its effects on quality of life (QOL), its economic impact, and its influence on societal activities, such as attendance at work or school. This dissatisfaction tended to be particularly pronounced among older patients and those who had multiple surgeries. The primary reasons given for avoiding surgery were "afraid of surgery," "no time for hospitalization and treatment," and "surgery is too expensive." CONCLUSION: Our research indicates that, although recipient patients are highly satisfied with the effectiveness of surgery for CRSwNP, a number of patients hesitate because of concerns about safety, cost, and societal activities such as work and school attendance. These findings suggest that treatment in a clinical setting should consider not only therapeutic effects but also the patient's attitude and situation.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Humanos , Pólipos Nasais/cirurgia , Qualidade de Vida , Rinite/cirurgia , Sinusite/cirurgia , Inquéritos e Questionários
20.
Acta Otorhinolaryngol Ital ; 41(5): 450-460, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34734581

RESUMO

Objective: We determined the influence of gastro-oesophageal reflux disease (GERD) on quality of life (QOL) before and after functional-endoscopic-sinus-surgery (FESS) for chronic rhinosinusitis (CRS). Methods: Medically-recalcitrant CRS patients were recruited prior to FESS. GERD was diagnosed endoscopically. QOL was compared between patients with vs without GERD at baseline and one-year post-FESS. Results: Of 187 CRS patients receiving FESS, 40 had GERD. Pre-operative QOL was significantly worse in CRS patients with vs without GERD. Pre-operative GERD health-related QOL (GERD-HRQL) and reflux symptom index (RSI) scores were both correlated with pre-operative SNOT-22 scores. Compared with non-GERD CRS patients, GERD patients demonstrated larger SNOT-22 improvements after FESS, such that post-operative SNOT-22 values were no longer significantly different between GERD and non-GERD groups. However, post-FESS, in patients with CRS without nasal polyps (unlike those with nasal polyps), the GERD (vs non-GERD) group suffered from greater sleep dysfunction and otologic/facial symptoms. Conclusions: Compared to CRS patients without GERD, those with GERD experienced poorer pre-operative QOL and greater QOL improvement after FESS.


Assuntos
Refluxo Gastroesofágico , Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Endoscopia , Refluxo Gastroesofágico/complicações , Humanos , Qualidade de Vida , Rinite/complicações , Sinusite/complicações
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