Effects of azathioprine and its metabolites on inflammatory cytokines in human nasal polyp organ cultures.

BACKGROUND: Oral steroids are recommended for the treatment of nasal polyps (NPs), but prolonged use is avoided because of side effects. Topical steroids can also control NPs without significant complications; however, the response to this is partially successful, and additional therapies are needed to treat glucocorticoid-resistant NPs. Azathioprine (AZA) and its first metabolite 6-mercaptopurine (6-MP) are important immunosuppressants used for the therapy of various diseases. The aim of this study was to investigate the effects of AZA and 6-MP on inflammatory cytokines in organ-cultured NPs. METHODS: NP explants were cultured using an air-liquid interface method. Cultures were maintained in the absence and presence of steroid, AZA, and 6-MP for 72 hours. Elaboration of cytokines tumor necrosis factor alpha (TNF-α), interleukin (IL)-2, IL-4, IL-5, and IL-13 into the supernatant was quantitated using the enzyme-linked immunosorbent assay (ELISA). The messenger RNA (mRNA) expression levels of TNF-α, IL-2, IL-4, IL-5, and IL-13 in cultured mucosa were measured using real-time polymerase chain reaction. Hematoxylin and eosin staining of cultured mucosa was performed to observe inflammatory cells. Immunohistochemistry was done to evaluate the distribution pattern of inflammatory cytokines in NP explants. RESULTS: On histologic examination, less inflammatory cell infiltration was found in NPs treated by steroid, AZA, and 6-MP than in control, but there was no statistical significance (p = 0.218). On immunohistochemistry, IL-13 showed a steady falling tendency in submucosal glands by steroid, AZA, and 6-MP. Expression of TNF-α, IL-2, IL-4, IL-5, and IL-13 mRNA in the NPs treated by steroid, AZA, and 6-MP were significantly lower than those of the control (p < 0.001 for all). By ELISA, IL-2 and IL-13 were significantly lower with topical steroid, AZA, and 6-MP treatment (p = 0.012 and p < 0.001). CONCLUSION: Topical AZT decreases inflammatory cytokines on human NP explants and this could have future therapeutic implications for NPs.

Is Facial or Head Pain Related to the Location of Lesions on Computed Tomography in Chronic Rhinosinusitis?

BACKGROUND: Facial or head pain is not an infrequent symptom among patients diagnosed with chronic rhinosinusitis (CRS), but few reports have investigated the pain in CRS, including the relationship between pain and sites of CRS. The aim of this study was to investigate whether pain is related to the location of lesions on computed tomography (CT) in CRS. METHODS: We analyzed 203 patients who underwent endoscopic sinus surgery (ESS) for 2 years. Patients were assessed using the questionnaires on pain, provided 1 day prior to the operation and 6 months post operation. Sites of CRS were evaluated using CT. We analyzed whether the degree of inflammation in each sinus had an effect on the location of pain. RESULTS: Seventy-eight patients (38.4%) had preoperative facial or head pain. There was no difference in the sinus inflammation scores in CT findings, based on the presence of pain. Pain was most commonly located in the periorbital area, followed by the frontal, vertex, occipital, and facial areas. No significant correlation was found between the sinuses and the location of pain. CONCLUSIONS: This study indicates that in CRS patients, several sites of pain are involved, particularly in the periorbital area; these sites were not found to be related to the location of CRS.

Initial effect of an elastic chest band during inspiratory exercise on chest function improvement in people with limited rib mobility: a randomized controlled pilot trial.

BACKGROUND AND PURPOSE: While performing respiratory training, an elastic chest band has great benefits for clinical use due to its safety and easy application. However, to our knowledge, there is no published data on the clinical use of an elastic chest band into inspiratory training for people with limited rib mobility. This study aimed to investigate the effects of an elastic chest band integrated into inspiratory exercise for people with decreased chest function. METHOD: Sixteen subjects with limited rib mobility were randomly assigned to either experimental group (EG) or control group (CG), with eight subjects in each group. All subjects received an inspiratory exercise using incentive spirometer for 30 minutes. For the subjects of the EG, an elastic chest band was incorporated into the inspiratory exercises to provide compressive resistance to the chest. The chest function was measured using an electronic spirometer to determine the vital capacity (VC), tidal volume (TV), inspiratory reserve volume (IRV), expiratory reserve volume, forced vital capacity (FVC), forced expiratory volume (FEV), FEV in 1-second (FEV1) and the ratio of FEV1 to FVC (FEV1 %). RESULTS: Significant differences were found for the VC, TV, IRV, FVC and FEV1 between pre-test and post-test in the two groups (p < 0.05). Further, the changes in the values of VC (0.47 L vs. 0.22 L), FVC (0.55 L vs. 0.25 L) and FEV1 (0.65% vs. 0.21%) in the EG subjects were significantly greater than those in the CG subjects (p < 0.05). CONCLUSIONS: These findings suggest that an elastic chest band combined with inspiratory exercise produces additional positive effect on improving chest function in people with limited rib mobility.