A possible role of Helicobacter pylori in chronic rhinosinusitis: a preliminary report

OBJECTIVE: The objective was to investigate the presence of Helicobacter pylori with polymerase chain reaction in the sinonasal mucosa of patients with or without chronic rhinosinusitis (CRS). STUDY DESIGN: A prospective clinical trial. METHODS: Mucosal tissue samples were collected from ethmoid cells of 12 patients with CRS and the removed mucosal part of the middle concha of 13 patients with concha bullosa who were treated surgically in our institution. DNA extracted from these samples was used for the amplification of 16S ribosomal RNA gene of H pylori by nested polymerase chain reaction. RESULTS: Helicobacter pylori DNA was detected in 4 of 12 patients with CRS, but it was not detected in patients with concha bullosa. Three of four patients with positive results for H pylori had gastroesophageal reflux-related complaints. CONCLUSIONS: It is possible to detect H pylori in the sinus mucosa of some patients with CRS. However, whether H pylori is a causative agent for CRS or a result of CRS is not known.     

Nods样模式识别受体在鼻息肉组织中的表达及意义

目的：探讨Nods（核苷酸结合寡聚化结构域,Nod Like receptors）样模式识别受体（PRR）在鼻息肉组织中的表达及作用。方法：分别采用实时定量RT—PCR、Western—Blot及免疫组织化学检测Nodl、Nod2、Nalp3mRNA及蛋白在鼻息肉组织中的表达（以正常下鼻甲黏膜作对照）。结果：实时定量RT—PCR显示,鼻息肉组织Nodl、Nod2、Nalp3mRNA表达与正常对照下鼻甲黏膜比较无显著差异。Western-Blot结果提示：鼻息肉组织Nodl表达高于对照组,两组Nod2、Nalp3无明显差异。免疫组织化学表明,三种模式受体在两组中均有表达,主要表达于上皮细胞、腺体上皮、炎性细胞（如嗜酸粒细胞）,但Nodl及Nalp3在鼻息肉中表达强于对照组（P〈0．05）,Nod2蛋白表达无显著差异。结论：在鼻息肉组织中,Nodl、Nod2及Nalp3均有表达,其中Nodl、Nalp3的表达高于对照组,说明Nodl、Nalp3有可能参与鼻息肉的发病。     

慢性咽炎患者咽分泌物中幽门螺杆菌的超高倍显微镜检测结果

目的 探讨超高倍显微镜检测慢性咽炎患者咽部分泌物中幽门螺杆菌(HP)的分布情况。方法 对慢性咽炎患者295例和正常对照30例,采用咽拭子均匀涂片,超高倍显微镜下观察,放大20?000倍,根据观察需要选择暗视野相差视野进行活体观察,由一名专业人员进行结果判定。卡方检验评价两组HP阳性率的差异。结果 慢性咽炎患者中229例咽部分泌物中检测到幽门螺旋杆菌（77.63%,229/295）,66例未发现HP（22.37%,66/295）;正常对照组中, 30例咽部分泌物中2例检测到幽门螺旋杆菌（6.67%,2/30）,其余28例（93.33%,28/30）幽门螺旋杆菌阴性,经卡方检验χ2=6.670,P＜0.05。结论 幽门螺旋菌可能是慢性咽炎患者咽部一种被忽视的致病菌,超高倍显微镜有可能成为筛查咽部分泌物中幽门螺旋菌的一种新方法,幽门螺旋菌感染与喉咽反流的关系还需要进行进一步研究证实。     

Comparison of subjective and objective assessment of glucocorticoid response in nasal polyps: a preliminary study

Background: Glucocorticoids (GC) therapeutic response in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) varies markedly.

Aims/Objectives: To compare the utility between subjective and objective assessment of GC sensitivity in reflecting the impact of GC on systemic and local eosinophilia in CRSwNP patients.

Material and methods: Twenty-six patients with CRSwNP were enrolled. All patients were given 30?mg of prednisone once daily for 7 days and subsequently classified into subjectively GC-sensitive and -insensitive subgroup or objectively GC-sensitive and -insensitive subgroup. The numbers of eosinophils and neutrophils in blood and polyp tissues were compared between GC-sensitive and GC-insensitive subgroup.

Results: 17/26 (65.4%) patients were subjectively and 8/26 (30.8%) patients objectively sensitive to GC treatment. The absolute number and percentage of eosinophils in blood were decreased both in GC-sensitive and -insensitive subjects after GC treatment. In addition, a significant reduction in tissue eosinophil percentage was only observed in objectively GC-sensitive subjects after GC treatment. Furthermore, the change of tissue eosinophil percentage in objectively GC-sensitive subjects was significantly higher than that in objectively GC-insensitive subjects.

Conclusions and significance: Objective assessment may better reflect oral GC response in tissue eosinophilic inflammation than subjective assessment in patients with CRSwNP.     

Detection of Helicobacter pylori in children with otitis media with effusion: a preliminary report

OBJECTIVE: To determine the presence of Helicobacter pylori in the middle ear effusion of patients with otitis media with effusion (OME) by polymerase chain reaction (PCR). STUDY DESIGN: A prospective study in patients with OME. METHODS: The study was performed in 38 patients with OME who were admitted to the ENT Clinic, Firat University from June 2003 to April 2004. In all cases, a myringotomy operation (with or without placement of a ventilation tube) was carried out. The effusion samples aspirated from the middle ear were analyzed with PCR assay. RESULTS: A total of 55 aspiration samples collected from 38 children ranging in age from 2 to 12 were included in the study. Fifteen of the subjects were girls, and 23 were boys. In 17 patients, both ears demonstrated effusions, whereas in 21 patients, only one ear had effusions. Nine (16.3%) of 55 the middle ear effusion samples were shown to be H. pylori positive by PCR. CONCLUSIONS: H. pylori was detected in the middle ear effusion of some patients with OME. These results may have interesting implications for a possible role of H. pylori in OME. In addition, these results suggest that further studies are needed to investigate the role of H. pylori in the etiology of OME.     

Detection of Helicobacter pylori in nasal and maxillary sinus specimens from patients with chronic sinusitis

OBJECTIVES: In patients with chronic sinusitis, the colonization of nasal and maxillary sinus tissues by Helicobacter pylori (HP) was investigated using polymerase chain reaction, urease test (CLO test), culture, and immunohistochemical analysis. STUDY DESIGN: A prospective clinical study. METHODS: The subjects were 11 patients aged 20 to 72 years with chronic sinusitis who had undergone sinus surgery under local anesthesia. In 7 of 11 patients, the HP status of the stomach was also studied. Nasal and maxillary sinus tissues were studied using polymerase chain reaction, urease test, culture, and immunohistochemical analysis. Helicobacter pylori infection of nasal and maxillary sinus tissues was defined by at least two positive results of different tests. RESULTS: Three (16%) of 19 nasal and maxillary sinus specimens from two patients were shown to be HP-positive (positive by polymerase chain reaction and immunohistochemical analysis and weakly positive by the CLO test). In one of these two patients, HP infection of the stomach was confirmed. In the other, a positive findings on immunohistochemical analysis suggested HP infection of the stomach. Immunoreactive structures were seen by immunohistochemical analysis in the nasal, maxillary sinus, and gastric specimens of these two patients but were partially degraded. CONCLUSION: Helicobacter pylori may exist in the nasal and maxillary sinus tissue specimens of some patients with chronic sinusitis with gastric HP infection.     

Helicobacter pylori colonization in the larynges of patients with hoarseness

OBJECTIVES: Vocal nodules and polyps are two common noninfectious causes of hoarseness. Patients with persistent hoarseness often require microscopic laryngeal surgery to excise mass lesions of the larynx despite extensive voice resting and modification of voice use behavior. Helicobacter pylori has recently been reported to present in the upper aerodigestive tract. This study applies the rapid urease test to determine the colonization of Helicobacter pylori in surgical specimens of patients with vocal nodules and polyps. METHODS: In this prospective study, 53 consecutive patients with vocal nodules (n = 20) or vocal polyps (n = 33) were investigated from November 2004 to July 2005. Microscopic laryngeal surgery was performed in all cases. Tissue specimens harvested from the larynx were analyzed using the rapid urease test. RESULTS: The study population consisted of 33 females and 20 males with a mean age of 43.1 +/- 9.9 years. Thirteen (24.5%) of the 53 patients revealed Helicobacter pylori colonization, and all were histopathologically diagnosed with vocal polyps. The difference in incidence of Helicobacter pylori colonization between vocal nodules and vocal polyps was statistically significant (0% [0/20] vs. 39.4% [13/33], P = .001). CONCLUSIONS: Helicobacter pylori often colonizes in the larynxes of patients with vocal polyps. These results indicate the involvement of Helicobacter pylori in vocal polyps. However, the presence of Helicobacter pylori as an etiologic factor in vocal polyps remains inconclusive.     

Effects of topical Amphotericin B on expression of cytokines in nasal polyps

Objective—Although chronic rhinosinusitis (CRS) is one of the most frequently reported chronic diseases its etiology is not well understood. Recently, fungi have been proposed to influence the chronicity of rhinosinusitis. If fungi do play an important role then topical antifungal treatment may improve the inflammatory process of CRS. Therefore, in this study we measured inflammatory cytokine levels in nasal polyps after intranasal antifungal irrigation.

Material and Methods—Nasal polyps were collected before and 4 weeks after treatment with 100 mg/l topical amphotericin B (n=16), 50 mg/l topical amphotericin B (n=14) or normal saline (n=11). The cytokine—IL-5, IL-8, interferon-γ, RANTES—protein content of polyp homogenates were determined by means of ELISA.

Results—Nasal polyps were found to contain large amounts of cytokines (IL-5, IL-8 and RANTES) compared with normal inferior turbinates. After 4 weeks of treatment with topical agents, IL-5 levels tended to decrease in comparison with those of the other cytokines, but this difference was not statistically significant.

Conclusions—Topical amphotericin B treatment and nasal saline irrigation both influence the expression of nasal polyp cytokines. Topical nasal irrigation may influence the inflammatory process of CRS.     

Role of free radicals and antioxidants in nasal polyps

OBJECTIVES/HYPOTHESIS: The aim of this study is to determine the role of free radicals and antioxidants in nasal polyps. STUDY DESIGN: Prospective, randomized, controlled study. METHODS: Thirty-one patients with nasal polyposis and a control group consisting of 19 patients with septal deviation and lower turbinate hypertrophy were included in the study. Levels of the antioxidants retinol, beta-carotene, alpha-tocopherol, and ascorbic acid were measured from the sera of the patients with nasal polyposis and the control group. Plasma levels of superoxide dismutase activity (SOD), glutathione peroxidase (GSHPX) activity, and reduced glutathione (GSH) were also obtained. As a peroxidation product, the levels of the malondialdehyde-thiobarbituric acid (MDA) combination were measured from the plasma of patient and control groups. Measurements of MDA, GSH, and alpha-tocopherol levels were also taken from the polyp tissue and turbinate mucosa of the control group. RESULTS: The blood levels of antioxidants and MDA as an oxidant were significantly different in the patient group compared with the control group (P <.01). The tissue levels of antioxidants and MDA were significantly different in the patients with polyposis compared with the control group (P <.01). The blood and tissue anti-oxidant levels were found to be decreased, and MDA levels as an oxidant increased significantly in the patient group with polyposis when compared with the control group, and there was a negative correlation between oxidative stress and antioxidants. CONCLUSION: This study demonstrates that oxidative stress and tissue and blood antioxidants in the patients with polyposis were significantly different compared with the control group. The blood and tissue antioxidant levels decreased, and MDA levels, as an oxidant, increased significantly in the patient group with polyposis when compared with the control group. The current study demonstrates that there is strong evidence related to oxidative stress in the pathogenesis of nasal polyposis, and antioxidants can have a preventive role in free-radical-mediated tissue damage in nasal polyposis.     

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。     

ERK5蛋白在鼻息肉细胞中的表达和意义

目的 探讨细胞外调节蛋白激酶5(ERK5)在鼻息肉细胞中的表达和意义。 方法 分析2013年1月至2014年12月接受治疗的慢性鼻-鼻窦炎(CRS)患者的临床资料,将其中37例慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者列为观察组(CRSwNP组),35例慢性鼻-鼻窦炎不伴鼻息肉(CRSsNP)患者作为对照组(CRSsNP组)。 结果 CRSwNP组患者血清中TNF-α(t=16.7,P<0.001)、IL-5(t=13.81,P<0.001)和IL-8(t=8.642,P<0.001)含量显著高于对照组,差异具有统计学意义(P>0.05);Western Boltting检测结果表明,在CRSwNP组中ERK5蛋白表达水平显著高于对照组中ERK5蛋白表达水平(灰度比1.21±0.16 vs 0.36±0.04,P<0.01,n=37);Pearson相关性检验分析结果表明,CRSwNP组患者ERK5蛋白表达与TNF-α(r=0.521,P=0.001)及IL-8(r=0.479,P=0.003)呈显著正相关。 结论 ERK5蛋白在CRSwNP患者中高水平表达,且与TNF-α及IL-8呈显著正相关关系。     

Superantigens and chronic rhinosinusitis: detection of staphylococcal exotoxins in nasal polyps

OBJECTIVE/HYPOTHESIS: The role of infectious agents in the etiology of chronic rhinosinusitis with nasal polyposis (CRSwNP) remains unclear. Recent studies have provided indirect evidence of exposure to staphylococcal exotoxins in the blood and polyp tissue of patients with CRSwNP. These exotoxins have the capacity to act as superantigens, bypassing normal antigen processing and directly stimulating a massive inflammatory response. The objective of the study was to analyze mucus and polyp tissue samples from patients with CRSwNP for the presence of staphylococcal exotoxins. STUDY DESIGN: Prospective study. METHODS: Tissue and mucus samples were obtained from 42 patients undergoing endoscopic sinus surgery for chronic rhinosinusitis and 11 normal control patients. Twenty-nine of 42 patients had chronic rhinosinusitis with bilateral nasal polyposis, 2 had antrochoanal polyps, and 11 had chronic rhinosinusitis without nasal polyps. Eleven patients without chronic rhinosinusitis or polyps served as normal control patients. Specimens were analyzed for the presence of five staphylococcal exotoxins (SEA, SEB, SEC, SED, and toxic shock syndrome toxin type 1 [TSST-1]) using enzyme-linked immunosorbent assay (ELISA). Histological analysis of specimens and mean eosinophil counts were correlated with the presence of toxin. RESULTS: At least one toxin was detected in 14 of 29 patients with bilateral nasal polyposis. Nine of the 14 patients also had positive findings for additional toxins. The dominant histological pattern in the CRSwNP patient group was polypoid mucosa with edema, which was found in both ELISA-positive and ELISA-negative patients. Mean eosinophil counts tended to be higher in ELISA-positive patients with polyps compared with patients without toxin detection. No toxin was detected in the 11 specimens taken from normal control patients. Only 1 of the 13 patients with CRS without polyps had positive ELISA results for toxin. CONCLUSION: The current study demonstrates the presence of superantigen toxins in 14 of 29 patients with CRSwNP, with SEB and TSST-1 being the most common. Further studies are necessary to correlate the presence of toxin with the pathological changes present in polyp tissue.     

Mucociliary function in patients with nasal polyps

Patients with nasal polyposis complain of nasal blockage and rhinorrhoea, which may be due to impaired mucociliary clearance. The saccharine clearance time and ciliary beat frequency of samples of ciliated epithelium from patients with nasal polyps was measured. We also studied the effect of fluid from the oedematous stoma of nasal polyps and of histamine and prostaglandin (PG) D₂ E₂ and F_2x on the cilia from normal individuals. Polyp fluid was found to increase ciliary beat frequency. Histamine and PGD2 had no effect, but PGE₂ and PGF_2x both increased ciliary beat frequency and so may cause the ciliostimulatory effect of polyp fluid. The saccharine clearance time was prolonged in three of nine patients, but ciliary beat frequency was only slightly reduced in one of these. Thus, where mucociliary clearance is reduced, it is likely to be due to abnormalities of mucus rather than impaired ciliary activity.     

嗜酸粒细胞型鼻息肉患者血清特异性IgE检测的临床分析

目的:探讨不同类型鼻息肉(NP)患者对吸入性变应原的超敏性及相关性。方法:将83例NP患者按息肉标本内嗜酸粒细胞(EOS)计数多少分为嗜酸粒细胞型鼻息肉(ENP)和非嗜酸粒细胞型鼻息肉(nENP),所有NP患者进行血清变应原特异性IgE(sIgE)检测及统计学分析。结果:ENP和nENP患者分别为27例(32.53%)、56例(67.47%),其血清变应原sIgE阳性者分别为16例(59.26%)、13例(23.21%),2种类型间比较差异有统计学意义(P<0.01);尘螨是NP组最常见的变应原。结论:常年性吸入性变应原与ENP患者有相关性。     

变应性因素及变应性鼻炎与慢性鼻-鼻窦炎鼻息肉的相关性探讨

目的：探讨变应性因素及变应性鼻炎（AR）与慢性鼻-鼻窦炎鼻息肉的临床相关性。方法：将200例研究对象分为A、B组,A组诊断为AR（110例）,B组诊断为慢性鼻-鼻窦炎鼻息肉（90例）,通过欧蒙印迹法定量检测血清sIgE浓度并观察慢性鼻-鼻窦炎鼻息肉手术治疗后的复发率、AR并发慢性鼻-鼻窦炎鼻息肉的发生率。结果：A组sIgE总阳性率为89.09%,B组sIgE总阳性率为74.44%。B组中sIgE阳性者术后复发率为58.21%,sIgE阴性者术后复发率为8.70%。A组41例（37.27%）并发慢性鼻-鼻窦炎鼻息肉,血清sIgE阳性率为97.56%;69例（62.73%）未并发慢性鼻-鼻窦炎鼻息肉,血清sIgE阳性率为79.71%;组内slgE阳性率比较差异有统计学意义（χ2=6.96,P〈0.01）。结论：变应性因素及AR与慢性鼻-鼻窦炎鼻息肉的发生有一定的相关性,提示避免接触变应原、合理治疗AR能够有效控制慢性鼻-鼻窦炎鼻息肉的复发率。     

Expression and distribution patterns of the stem cell marker,nestin, and the stem cell renewal factor,BMI-1, in normal human nasal mucosa and nasal polyps

Conclusions: These results suggest that nestin and BMI-1 are candidates for stem cell markers and renewal factors in human nasal mucosa, may contribute to tissue homeostasis and differentiation in the epithelium and submucosal glands of normal nasal mucosa, and may play a role in proliferation of nasal polyps. Objectives: The stem cell marker, nestin, and the stem cell renewal factor, BMI-1, have been identified in a variety of inflammatory and normal tissues, implicating these markers in tissue regeneration. Materials and methods: We investigated the expression and distribution of nestin and BMI-1 in normal nasal mucosa and nasal polyps, using RT-PCR, immunohistochemistry, and Western blotting. Results: Nestin and BMI-1 were localized to the epithelium and submucosal glands of normal nasal mucosa and nasal polyps. The expression of nestin was confined to the plasma membrane and cytoplasm, whereas BMI-1 showed a nuclear staining pattern. In normal nasal mucosa and nasal polyps, nestin and BMI-1 expression was strongest in the basal portion of the epithelial layer, and decreased toward the upper portion. In the submucosal glands, weak to strong expression was commonly detected in the glandular acini. There was no significant difference in the level of expression of nestin and BMI-1 between normal nasal mucosa and nasal polyps.