Evaluation of aspirin hypersensitivity in patients with chronic rhinosinusitis

Conclusion The recurrence rates of chronic rhinosinusitis (CRS) were higher in the aspirin nasal provocation test (ANPT)-positive group, regardless of the presence of nasal polyps. Thus, a careful endoscopic examination is required during follow-up in ANPT-positive patients with CRS. Objectives The aim of this study was to evaluate the clinical features and prognosis after surgical treatment in patients with CRS and aspirin hypersensitivity. Methods In a prospective study, 100 patients were analyzed with CRS who underwent endoscopic sinus surgery at the hospital from October 2012 to March 2013. This study measured changes in nasal volume and symptoms before and after the ANPT and examined patient’s asthma history, allergy, Lund–Mackay score (LMS), total immunoglobulin E, percentage of peripheral eosinophils, and objectively measured relapse at 6 months. Results Patients wwith CRS and nasal polyps (CRSwNP) were more likely to have a positive ANPT test result compared to those without nasal polyps (CRSsNP) (21.4% vs 5.5%). The ANPT-positive group had a higher LMS and required more revision endoscopic sinus surgery than those in the ANPT-negative group. The results were that similar results were observed in CRSwNP and CRSsNP.     

Effects of pepsin A on heat shock protein 70 response in laryngopharyngeal reflux patients with chronic rhinosinusitis

Objectives: We investigated the relationship between laryngopharyngeal reflux (LPR) and chronic rhinosinusitis (CRS), and explored the effects of pepsin A on the level of heat shock protein 70 (HSP70) in CRS.

Methods: We included 23 CRS patients with nasal polyps (CRSwNP), 26 CRS patients without nasal polyps (CRSsNP) and nine normal controls to measure pepsin A levels in nasal secretions, blood plasma and nasal tissues, to measure HSP70 levels in nasal tissues, and to detect pepsinogen A, HSPA5, cyclo-oxygenase-2 (COX-2), and carbonic anhydrase III (CAIII) mRNA expression levels in nasal tissues.

Results: Pepsin A levels in nasal secretions were significantly higher in CRSwNP/CRSsNP patients than in controls. HSP70 levels were significantly increased in pepsin A-positive turbinate mucosa compared to controls (p?p?=?.016). Furthermore, no association was found between the presence of pepsin A and HSPA5, COX-2, and CAIII mRNA expression levels.

Conclusions: These results suggest that LPR may play a role in the development of CRS through pepsin A reflux, and increased HSP70 expression may be associated with the pathogenic mechanism of mucosal injury in CRS.     

Amphotericin B irrigation for the treatment of chronic rhinosinusitis without nasal polyps: a randomized, placebo-controlled, double-blind study

BACKGROUND: Fungus-driven inflammation is proposed to play an important role in the pathogenesis of chronic rhinosinusitis (CRS). Previous studies tested the efficacy of intranasal antifungal agents for patients with nasal polyps. The purpose of this study was to evaluate the efficacy of intranasal amphotericin B (AMB) in patients who have CRS without nasal polyps (CRSsNP). METHODS: Patients diagnosed with CRSsNP were enrolled in this study. They were assigned randomly to receive irrigation with AMB solution (20 mg of AMB in 500 mL of normal saline) or placebo (yellowish dye in 500 mL of normal saline) for 4 weeks. The outcome measures included the Chinese version of the Rhinosinusitis Outcome Measure 31 (CRSOM-31), nasal endoscopy, and bacterial and fungal cultures. RESULTS: Seventy patients were enrolled and 64 patients completed this study. There was significant improvement in the AMB group (n = 32) both in endoscopic (p = 0.013) and CRSOM-31 scores (p < 0.0001). The placebo group (n = 32) showed significant improvement in CRSOM-31 scores (p < 0.0001). CRSOM-31 scores were significantly lower in the AMB group than in the placebo group after 2-week treatment (p = 0.018) and remained lower after 4-week treatment, although the difference was not significant (p = 0.091). There were no significant differences in endoscopic scores and bacterial or fungal culture rates between two groups after treatment. CONCLUSION: Our results showed that AMB irrigation improved symptoms and endoscopic scores but did not show superiority to saline irrigation alone in patients who have CRSsNP.     

慢性鼻-鼻窦炎患者鼻腔黏膜CD55和CD59的表达及其意义

目的　通过观察CD55和CD59在慢性鼻-鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyp,CRSwNP）组织中的表达。探讨其与CRSwNP发病的关 系。方法　采用免疫组织化学方法检测60例CRS患者,分为CRSwNP组和慢性鼻-鼻窦炎不伴鼻息肉（chronic rhinosinusitis without nasal polyp,CRSsNP）组,鼻腔黏膜及鼻息肉组织中CD55和CD59的表达,并以30例单纯行鼻中隔偏曲矫正术患者为对照组。观察CD55和CD59在细胞中的表达情况。结果　CD55和CD59在对照组及CRSwNP组织中均有表达,二者在对照组的表达高于CRSwNP组织（P <0.05,P <0.01）。与CRSsNP组相比,CRSwNP组CD55和CD59表达进一步下降（P <0.05）。结论　CRSwNP患者鼻腔黏膜CD55和CD59表达降低,提示补体调节蛋白表达下降,进而导致补体活化,可能参与CRS发病机制。     

Difference between CD25+Tregs and Helios+Tregs in a murine model of allergic rhinitis

IntroductionRegulatory T or Treg cells, balance the peripheral immune response to allergens in allergic rhinitis. Traditionally, Treg (CD25⁺ Treg) is identified by the coexpression of Foxp3 and CD25, but this strategy does not represent the true inhibitory function of Treg cells. Helios has been thought of as novel marker of activated Tregs, with an important inhibitory function. Consequently, Helios was proposed as a marker of Treg. Recent articles have shown that Foxp3 and Helios co-expression (Helios⁺Tregs) is an important functional stage of Treg.ObjectiveTo compare the prevalence of CD25⁺Tregs and Helios⁺Tregs using a mouse model of allergic rhinitis.MethodsTwenty mice were randomized into two groups. The test group comprised 10 allergic rhinitis model mice exposed to ovalbumin; the control group was exposed to saline. The fractions of CD25⁺Tregs, Helios⁺Tregs, Helios⁺CD25⁺, and Helios⁺Foxp3⁺CD25⁺Tregs present in the two groups were determined using flow cytometry.ResultsCD25⁺Tregs and Helios⁺Tregs were less abundant in the spleen and nasal mucosa cells of the allergic rhinitis model compared with the control. We also observed fewer Helios⁺Tregs than CD25⁺Tregs in nasal mucosa and splenic cells of both control and test groups. Moreover, we observed fewer Helios⁺Foxp3⁺, Helios⁺CD25⁺, and Helios⁺Foxp3⁺CD25⁺ Tregs in the nasal mucosa in the allergic rhinitis model. Helios was expressed the most in CD4⁺ CD25⁺Foxp3⁺ T-cells, followed by CD4⁺ CD25⁻Foxp3⁻ T-cells. Approximately 75% of CD25⁺Tregs were Helios⁺ in spleens of allergic rhinitis and control mice.ConclusionThis is the first report of the proportions of Helios⁺Tregs in nasal mucosa and spleens of allergic rhinitis mice. Gating true inhibitory Tregs with the coexpression of Foxp3 and Helios might be more useful than relying on the expression of CD25. This study provides a new insight for Treg studies of allergic rhinitis, and the potential utility of the marker as a therapeutic target.     

CD4+ T cells induce productions of IL-5 and IL-13 through MHCII on ILC2s in a murine model of allergic rhinitis

ObjectiveCD4⁺ T cells play an important role not only in the induction of allergy but also in allergic inflammation. Group 2 innate lymphoid cells (ILC2s) also mediate type 2 immune responses in allergic rhinitis (AR). However, the relationships between CD4⁺ T cells and ILC2s in allergic condition are currently not well defined. The study aimed to evaluate the potential influences of CD4⁺ T cells on ILC2s in the murine model of AR.MethodsA murine model of AR was established using ovalbumin (OVA), and OVA-induced ILC2s were sorted and purified from the mouse nasal-associated lymphoid tissue (NALT), and cultured in vitro. Then, the expression of major histocompatibility complex class II (MHCII) on ILC2s was examined. CD4⁺ T cells were separated from AR mice peripheral blood mononuclear cells (PBMCs). After that, productions of IL-5 and IL-13 on ILC2s cultures were assessed when CD4⁺ T cells or plus anti-MHCII antibody or anti-CD4 antibody were administered into the cultures. Finally, we adoptively transferred ILC2s alone or ILC2s plus anti-MHCII antibody to the murine model of AR to investigate their roles in the nasal allergic inflammation.ResultsWe showed that ILC2s could be induced by OVA in the mouse NALT. The number and percentage of ILC2s in AR mice were increased. MHCII was expressed on ILC2s, and its protein and mRNA were all enhanced in allergic condition. IL-5 and IL-13 proteins and mRNAs were elevated after CD4⁺ T cells administration, and were reduced after these cells plus anti-MHCII antibody or anti-CD4 antibody application. Numbers of sneezing and nasal rubbing as well as counts of eosinophils in nasal lavage fluid (NLF) were all enhanced after the adoptive transfer of ILC2s when compared to AR mice. IL-5 and IL-13 in the NLF of allergic mice were also increased in comparison with AR group. However, above parameters were all decreased after the transfer of ILC2s plus anti-MHCII antibody versus AR mice or ILC2s-treated ones.ConclusionThese findings show that CD4⁺ T cells induce productions of IL-5 and IL-13 through MHCII on ILC2s in AR mice models.     

淋巴细胞在慢性鼻-鼻窦炎组织中的表达及意义

目的：探讨B淋巴细胞（CD20）和T淋巴细胞亚群（CD4、CD8）在慢性鼻-鼻窦炎（CRs）中的表达及在炎症反应中的作用。方法：采用免疫组织化学技术检测B淋巴细胞（CD20）和辅助性T细胞（CD4）、细胞毒性T细胞（CD8）在实验组[分为15例CRS不伴鼻息肉（CRSsNP）组、12例CRS伴鼻息肉（CRSwNP）组、7例复发性CRSwNP组]和对照组（13例下鼻甲黏膜对照）中的表达。采用Mann-WhitneyU检验分析实验组和对照组B淋巴细胞、T淋巴细胞亚群的表达情况,实验组组间淋巴细胞浸润比较用单因素方差分析One—WayANOVA。结果：与对照组相比,实验组有明届的13淋巴细胞（CD20）和T淋巴细胞亚群（CD4、CD8）浸润（P〈0．05）：T淋巴细胞、亚群（CD4、CD8）在CRSwNP组和复发性CRSwNP组病变中的表达明显高于CRSsNP组（P〈0．05）;CD4在复发性CRSwNP组中的表达明显高于CRSwNP和CRSsNP组（P〈0．01）。结论：实验组鼻腔黏膜中B淋巴细胞、辅助性T细胞和细胞毒性T细胞高表达,均参与炎症的形成,其炎症匣应与T淋巴细胞浸润密切相关。     

Metallothionein-3 is a clinical biomarker for tissue zinc levels in nasal mucosa

ObjectiveRecently, depleted tissue zinc levels were found in nasal mucosa from patients with chronic rhinosinusitis (CRS) in correlation with tissue eosinophilia, however, no clinical biomarkers for tissue zinc levels have been identified. Metallothionein-3 (MT3) is an intracellular zinc chelator and previous data showed MT3 mRNA levels to be reduced in CRS patients with nasal polyps (CRSwNP). In this study, we examined the correlation between MT3 expression and zinc levels in nasal mucosa and primary human nasal epithelial cells (HNECs) to investigate whether MT3 could be a clinical biomarker for tissue zinc levels.MethodTissue was harvested from 36 patients and mounted on tissue micro-array (TMA) slides. MT3 expression and tissue zinc fluorescence intensity were measured at different areas within the mucosa (surface epithelium and lamina propria) and compared between controls, CRSwNP and CRS without nasal polyps (CRSsNP) patients. MT3 mRNA and protein expression were examined in zinc-depleted HNECs by qPCR and immunofluorescence microscopy.ResultsMT3 expression in CRSwNP was significantly decreased in both surface epithelium (p<0.001 to controls) and lamina propria (p = 0.0491 to controls). There was a significant positive correlation between tissue zinc levels and MT3 expression in nasal mucosa (r = 0.45, p = 0.007). In zinc-deplete HNECs, MT3 expression was significantly decreased at mRNA (p = 0.02) and protein level (p<0.01). There was a significant positive correlation between tissue zinc levels and MT3 expression within individual HNECs (r = 0.59, p<0.001).ConclusionsMT3 expression reflects intramucosal zinc levels in both nasal mucosa and HNECs indicating MT3 could be used as a clinical biomarker for monitoring intracellular zinc levels in the nasal mucosa.     

The effect of the H2 antagonist cimetidine on the numbers of CD4+ and CD8+ cells in the nasal mucosa of patients with allergic rhinitis

This paper reports the effects of the H₂ antagonist cimetidine on the number of CD4⁺ and CD8⁺ cells in nasal mucosa and the IgE level of nasal secretions in patients with allergic rhinitis. The results showed the numbers of CD4⁺ cells were greater than the numbers of CD8⁺ cells in nasal mucosa, both in the patients with allergic rhinitis and normal subjects, but the ratio of CD4⁺ : CD8⁺ cells was much higher in the patients with allergic rhinitis. After treatment with cimetidine locally for 4 weeks, the numbers of CD4⁺ cells fell and the numbers of CD8⁺ cells increased in the patients with allergic rhinitis. The high IgE level of nasal secretion of the patients with allergic rhinitis was much reduced after treatment with cimetidine. The results suggest that there are high numbers of CD4⁺ cells and lower numbers of CD8⁺ cells in the nasal mucosa and a high level of IgE in the nasal secretions of the patients with allergic rhinitis. Treatment with cimetidine locally may be of some value to relieve the clinical symptoms of allergic rhinitis.     

T细胞在慢性鼻窦炎中的作用机制

慢性鼻窦炎(CRS)的基本病理特征为鼻窦黏膜的慢性炎症反应,其发病机制尚未完全阐明,但目前认为免疫应答紊乱及免疫细胞分化异常密切相关。已有研究表明,各种亚型的T细胞及其分泌的炎性因子都对CRS的发生发展具有一定的推动作用。Th1细胞介导细胞免疫,Th2细胞介导体液免疫,CRS患者体内存在Th1和Th2细胞比例失衡,当Th2免疫活性过度增高,造成Th2细胞浸润鼻黏膜局部,Th2细胞分泌的IL-4在鼻黏膜组织和血清中的含量明显增加。IL-4可以对Th1细胞产生抑制作用,让T细胞与B细胞的相互作用得到增强,进一步促进体液免疫应答。本文重点对CD4⁺T细胞、CD8⁺T细胞在CRS中的发生机制进展进行综述分析。     

Effect of Chronic Rhinosinusitis With or Without Nasal Polyp on Quality of Life in South Korea: 5th Korea National Health and Nutrition Examination Survey Korean

ObjectivesThis is the first study of its kind to investigate the relationship between chronic rhinosinusitis (CRS) with or without nasal polyps (NP) and health-related quality of life (HRQoL) in the general adult Korean population. We sought to evaluate the association after adjustment for confounding factors. We also evaluated HRQoL according to presence of NP in CRS patients.MethodsIn this cross-sectional study we used nationally representative samples from the 5th Korea National Health and Nutrition Examination Survey (2010–2012). A total of 17,490 participants were included in the study, of which 613 were diagnosed with CRS. Univariate analysis was conducted on healthy versus CRS groups, segregated by gender with weighted prevalence of demographic characteristics, socioeconomic status, and comorbid diseases. Subanalysis was carried out to evaluate the relationship between CRS with or without NP and HRQoL using EuroQol 5-dimension (EQ-5D) and visual analog scale (EQ-VAS). The odds ratios for EQ-5D were estimated by multiple logistic regression analyses with confounder adjustment.ResultsWeighted prevalence of CRS of adult male was found to be 3.7% and CRS with nasal polyps (CRSwNP) 0.5%, while female CRS was 3.3% and CRSwNP 0.3%. There was no significant difference between the groups (P#x0003d;0.332). The scores for female, EQ-5D index (P for trend<0.001) and EQ-VAS (P for trend=0.002) showed decreasing trend from healthy participants to CRS without nasal polyps (CRSsNP) and from CRSsNp to CRSwNP. After adjusting for demographic characteristics, socioeconomic status, and comorbid diseases, EQ-5D scores; EQ-5D index (P<0.001) and EQ-VAS (P<0.001) exhibited poorer HRQoL compared to healthy participants, exclusively within the female group.ConclusionThese data suggest that female patients with CRS are at higher risk of poor HRQoL. In addition, HRQoL of female CRSwNP was lower compared to those of CRSsNP and healthy participants.     

Impact of endoscopic sinus surgery on otologic symptoms associated with chronic rhinosinusitis

ObjectiveTo evaluate improvements in otologic symptoms after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS), and identify differences in symptoms, if any, between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyposis.Material and methodsThis is a prospective multi-center observational cohort study. Adults with medically recalcitrant CRS who elected ESS were enrolled in a prospective, multi-center, observational cohort study between March, 2011 and October, 2014. Preoperative evaluation of subjects included assessment of clinical characteristics, measures of disease severity, and quality of life evaluation using the 22-item SinoNasal Outcome Test (SNOT-22). Postoperative improvement in otologic symptoms (ear fullness, dizziness, ear pain) scores were evaluated and compared between CRSwNP and CRSsNP subgroups.ResultsThree hundred and ninety-five study patients completed both preoperative and postoperative evaluations, with an average follow-up of 13.9 months after ESS. The prevalence of patients reporting at least one otologic symptom preoperatively (87%) significantly decreased after ESS (63%, P < 0.001). Significant postoperative improvement across all otologic scores was also reported (P < 0.001). Relative mean improvement in otologic symptom severity was similar for both CRSwNP and CRSsNP, except patients with CRSwNP reported significantly greater postoperative improvement in ear fullness compared to CRSsNP (54% vs. 41%, P = 0.039). A total of 61%, 44%, and 43% of patients reported experiencing improvement in “ear fullness”, “dizziness” and “ear pain”, respectively.ConclusionSinus surgery significantly improves otologic symptoms associated with CRS. CRSwNP patients reported slightly greater relief of ear fullness than CRSsNP patients following ESS.     

缺氧诱导因子1α与黏蛋白5在慢性鼻-鼻窦炎组织中的表达与意义

目的：探讨缺氧诱导因子1α（hypoxia-inducible factor-1α,HIF-1α）与黏蛋白5AC（MUC5AC）、黏蛋白5B （MUC5B）mRNA在慢性鼻-鼻窦炎（CRS）中的表达水平及其相关性。方法选82例CRS伴鼻息肉（CRS with nasal polyps,CRSwNP）组、88例CRS不伴鼻息肉（CRS without nasal polyps,CRSsNP）组以及15例正常上颌窦口黏膜作为对照组。收集3组鼻窦黏膜,采用免疫组织化学法和逆转录定量PCR（qRT-PCR）检测HIF-1α与MUC5AC、MUC5B的表达并分析相关性。结果①免疫组化结果：光镜下, CRSsNP或CRSwNP组中黏膜上皮MUC5AC的染色更多,主要位于胞浆内,呈浅黄色或棕黄色颗粒;MUC5B主要在黏膜下腺腺体的黏液细胞中表达;HIF-1α主要定位在黏膜上皮细胞核,在胞浆内也有表达,呈浅黄色或棕黄色颗粒,较对照组明显增多。②qRT-PCR结果：CRSwNP组中HIF-1α、MUC5AC、MUC5B mRNA的相对表达量分别为1.565±0.145、0.980±0.215、1.432±0.263;CRSsNP组中相对表达量分别为1.612±0.253、0.901±0.279、1.509±0.289;对照组中相对表达量分别为0.381±0.162、0.357±0.164、0.400±0.218;CRSsNP组、CRSwNP组与对照组比较差异均有统计学意义（P均<0.05）。CRSsNP组、CRSwNP组中HIF-1α与MUC5AC、MUC5B mRNA的表达均呈正相关（CRSwNP组：r=0.501、0.676,CRSsNP组：r=0.527、0.601,P均<0.05）。结论 HIF-1α与MUC5AC、MUC5B mRNA在CRS中表达水平明显升高,且HIF-1α与MUC5AC、MUC5B mRNA表达存在密切联系。     

Notch通路在鼻息肉中的表达及其与调节性T细胞表达和嗜酸粒细胞浸润的相关性研究

目的:探讨Notch通路在鼻息肉中的表达及其与调节性T细胞（Treg细胞）表达和嗜酸粒细胞（Eos）浸润的相关性。方法:选择2012年11月至2018年8月期间在中山大学附属第三医院接受鼻内镜手术的慢性鼻窦炎（CRS）和鼻中隔偏曲的患者,分别作为CRS组和对照组。收集慢性鼻窦炎不伴鼻息肉（CRSsNP）患者（30例,男...     

Effects of chamomile extract nasal drop on chronic rhinosinusitis treatment: A randomized double blind study

ObjectivesRecently, more attention has been paid to herbal treatment in chronic rhinosinusitis (CRS) patients. Chamomile (Matrricaria chamomilla) has extensive clinical uses in traditional-Persian medicine for its therapeutic properties. This study aimed to evaluate the effects of chamomile extract on the clinical symptoms of patients with CRS in a university hospital.Materials and methodsIn a randomized double-blind placebo-group clinical trial, 74 CRS patients were examined by an otolaryngologist blinded to the study groups, and the effects of treatment (according to SNOT-22 questionnaire) and possible complications recorded. Statistical analysis performed using SPSS software version 21, and level of significance considered as P < 0.05.ResultsOf the 74 patients (31 females and 43 male), 37 cases randomized in the intervention and 37 cases in the placebo group. The Lund-Mackay score, clinical findings in endoscopic nasal examination and mean score of the SNOT-22 were not significantly different at baseline visit between the two study groups. The adjusted mean score of quality of life during the four time periods in the intervention group (34.3, confidence interval of 95%: 31.8–36.7) was significantly lower than that of control group (45.9, confidence interval of 95%: 43.5–48.4) (P-value = 0.001). Also, clinical improvement in endoscopic nasal examination was significant in intervention group compared with placebo group.ConclusionChamomile extract is effective in further reducing the clinical symptoms and improving the quality of life of CRS patients.     

Effectiveness of micronized nasal irrigations with hyaluronic acid/isotonic saline solution in non-polipoid chronic rhinosinusitis: A prospective,randomized, double-blind,controlled study

BackgroundSodium hyaluronate has been proposed as a treatment for improving the symptoms of chronic rhinosinusitis. The present study evaluated the effect of the intranasal administration of hyaluronic acid in a group of patients affected by chronic rhinosinusitis without nasal polyps (CRSsNP).Materials and methodsThirty subjects aged 18–65 years affected by CRSsNP were enrolled. The subjects were randomly administered hyaluronic acid or isotonic saline solution by nasal nebulizer twice per day for 30 days. They were evaluated before (T0) and after the treatment (T1) with Sino-Nasal Outcome Test-22, visual analogue scale for rhinorrhea, nasal obstruction, facial pain and hyposmia/hypogeusia, nasal endoscopy, active anterior rhinomanometry, peak nasal inspiratory flow and nasal cytology.ResultsComparing the study and the control group, at T1 no significant differences were observed in both objective and subjective parameters. Being included in the study group rather than in the control group did not have a significant effect on the variation of the considered parameters between T0 and T1. Considering the effects of the micronized douches independently from the type of solution used (either hyaluronic acid or isotonic saline solution), although no difference emerged between study and control group for any of the objective parameters, there was an improvement of Sino-Nasal Outcome Test-22 scores (p = .0005), visual analogue scale for nasal obstruction (p = .0006) and for hyposmia/hypogeusia (p = .04).ConclusionsThe treatment with micronized nasal douches can improve the sino-nasal symptoms of CRSsNP, in particular nasal obstruction and olfactory ability. No advantage of the use of hyaluronic acid over isotonic saline solution emerged.     

Influencia de la premedicación con esteroides sistémicos en el sangrado y visualización del campo quirúrgico durante la cirugía endoscópica nasosinusal

IntroductionChronic rhinosinusitis (CRS) is the inflammation of the nasal and paranasal sinus mucosa persisting for at least 12 weeks. The success of endoscopic sinus surgery (ESS) depends on minimising oedema and intraoperative bleeding. For this purpose, some surgeons advocate the use of preoperative systemic steroids (SS).Our aim was to assess if the administration of preoperative SS in patients with CRS with or without nasal polyps (NP) facilitates the surgical procedure.MethodsNon-randomized clinical trial in CRS patients with or without NP. Patients in the ESS group received oral meprednisone preoperatively, whereas the control group did not. The visibility of the surgical field, intraoperative bleeding and surgery duration were recorded.ResultsEach group (SS group and control group) included 27 patients. The administration of SS reduced the values of all the parameters in patients without NP, with no significant differences. In patients with NP, only operative bleeding was reduced significantly.ConclusionsEven though all the parameters decreased with the preoperative administration of SS, only operative bleeding was significantly reduced in patients with CRS with NP.     

嗜酸性粒细胞与慢性鼻-鼻窦炎伴鼻息肉的相关性研究进展

慢性鼻窦炎（chronic rhinosinusitis,CRS）是鼻腔黏膜和鼻窦黏膜的慢性炎性疾病,根据有无鼻息肉可分为慢性鼻-鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps,CRSwNP）和慢性鼻-鼻窦炎（chronic rhinosinusitis without nasal polyps,CRSsNP）。鼻息肉组织常见有嗜酸性粒细胞(eosinophils,EOS) 浸润增多,根据嗜酸性粒细胞的浸润程度可将CRSwNP分为两个亚型：嗜酸粒细胞型慢性鼻窦炎伴鼻息肉(eosinophilic chronic rhinosinusitis with nasal polyps, ECRSwNP)和非嗜酸粒细胞型慢性鼻窦炎伴鼻息肉 (nonesinophilc chronic rhinosinusitis with nasal polyps,nonECRSwNP);将慢性鼻窦炎分为：嗜酸粒细胞型慢性鼻窦炎（eosinophilic chronic rhinosinusitis, ECRS)和非嗜酸粒细胞型慢性鼻窦炎(non eosinophilic,NECRS)。嗜酸性粒细胞在鼻息肉形成、发展机制中的作用多年来一直备受学者们关注。随着研究的不断深入,嗜酸性粒细胞在鼻窦炎鼻息肉炎症趋化、息肉形成、分型和预后中的作用得到越来越多的重视。     

Chronic rhinosinusitis patients with polyps or polypoid mucosa have a greater burden of illness

BACKGROUND: Recent studies suggest chronic rhinosinusitis without nasal polyposis (CRSsNP) and CRS with nasal polyposis (CRScNP) represent distinct pathological entities. The aim of this study was to determine whether patients with CRSsNP, CRScNP, and polypoid CRS could be distinguished by clinical features, radiologic extent of disease or use of medications. METHODS: New patients with CRS (n = 126) were enrolled in a prospective outcomes study. Rhinoscopic evaluation was used to classify patients. The relationship between disease phenotype and clinical parameters was examined. RESULTS: Facial pain/pressure/headache was more prevalent in CRSsNP than CRScNP (p = 0.01). Nasal obstruction and hyposmia/ anosmia were more prevalent in CRScNP than CRSsNP (p = 0.025 and 0.01, respectively). Intermediate symptom prevalence was found in polypoid CRS. Multivariate analysis confirmed that prior surgery, CT scan score, and male gender were independent predictors of polyp/polypoid phenotype. Allergic status was unrelated to CRS classification. Medication use was higher in CRScNP patients than in CRSsNP patients. CONCLUSION: Compared with CRSsNP, patients with CRScNP have a greater burden of symptoms, more prior surgery, higher CT scan scores, and greater use of medications.