ABSTRACT
Objective@#To study the value of olfactory cleft scores through computed tomography (CT) in predicting the oral glucocorticoids (GC) sensitivity in chronic rhinosinusitis with nasal polyps.@*Methods@#Fourty-seven consecutive patients with CRSwNP from the Fifth Affiliated Hospital of Sun Yat-sen University between January and March of 2018 were recruited in this prospective, single-blinded study. There were 28 males and 19 females, with age ranging from 17 to 66 years old. After a course of oral prednisone (30 mg/d for 14 d), these patients were subsequently classified into objectively GC-sensitive and -insensitive subgroup according to the change in nasal polyp size score, or subjectively GC-sensitive and -insensitive subgroup according to the change in total nasal symptom score. The following parameters were compared between GC-sensitive and -insensitve subgroups: Lund-Mackay scores, olfactory cleft scores, and blood eosinophil counts and ratio. T test and χ2 test were used. Multivariate Logistic regression analysis was used for factor prediction and receiver operating characteristic (ROC) curve was used to analyze the predictive ability of those factors.@*Results@#There were 53.2% (25/47) and 61.7% (29/47) of patients objectively and subjectively sensitive to GC therapy, respectively. All data conformed to normal distribution. The olfactory cleft score and the blood eosinophil counts and ratio in objectively GC-sensitive subgroup were significantly higher than those in objectively GC-insensitive subgroup (3.6±1.0 vs 2.2±1.4, (404.4±200.3)/μl vs (209.5±233.1)/μl, (5.25±2.59)% vs (3.17±3.46)%, t value was 3.98, 3.08, respectively, χ2=2.35, all P<0.05). The cleft score, the blood eosinophil counts and ratio also showed the same trend in subjectively GC-sensitive and -insensitive subgroup (3.6±1.0 vs 1.9±1.3, (401.4±213.6)/μl vs (171.1±200.2)/μl, (5.39±2.76)% vs (2.48±2.99)%, t value was 5.05, 3.68, respectively, χ2=3.40, all P<0.05). Multivariate Logistic regression revealed that olfactory cleft score was an independent risk factor for objective or subjective GC-sensitivity (OR=2.882, 95%CI: 1.301-6.384; OR=2.508, 95%CI: 1.248-5.039). The olfactory cleft score exhibited comparable accuracy with the blood eosinophil ratio as predictor of objective and subjective GC-sensitivity (Area under curve of olfactory cleft score was 0.775, 0.829, respectively). An olfactory cleft score of 3.5 could act as a reliable indicator for predicting the clinical response to GC therapy in CRSwNP.@*Conclusion@#Olfactory cleft score through CT scan has the potential value in predicting GC-sensitivity in CRSwNP patients.
ABSTRACT
BACKGROUND:Several studies have demonstrated that mesenchymal stem cel s exhibit strong immunomodulation on al ergic asthma. However, there are no reports to compare therapeutic effects under different administration ways. OBJECTIVE:To examine the immunomodulatory effects of MSCs via different administration routes on asthmatic mice. METHODS:Seventy-two Balb/c mice experienced three independent tests, and 24 mice were selected for each test. Twenty-four mice were randomly divided into four groups (n=6):control group, model group, intravenous treatment group and intratracheal treatment group. The mouse model of asthma was induced via intraperitoneal injection of ovalbumin at 1, 7, 14 days and 30-minute aerosol inhalation of ovalbumin at 22-26 days. In the latter two groups, mesenchymal stem cel s were injected intravenously (200μL, 5×109/L) or intratracheal y (50μL, 2×109/L) into the mice at 1 day before aerosol inhalation. RESULTS AND CONCLUSION:Compared with the control group, the airway inflammatory response was significantly increased in the model group. Intravenous administration of mesenchymal stem cel s significantly al eviated the symptoms of al ergic airway inflammation, including the airway hyperreactivity, the inflammatory cel counting in the bronchoalveolar lavage fluid, inflammatory cel infiltration in the lung tissue. Meanwhile, the levels of Th2 type cytokines in the bronchoalveolar lavage fluid and IgE in serum also decreased after intravenous administration of mesenchymal stem cel s. However, the intratracheal application of mesenchymal stem cel s did not exhibit the similar effects. Intravenous, not intratracheal, application of mesenchymal stem cel s can exert immunomodulatory effects through the blood circulation.