Incidence and prognosis of olfactory and gustatory dysfunctions related to infection of SARS-CoV-2 Omicron strain: a national multi-center survey of 35 566 population / 中华耳鼻咽喉头颈外科杂志

Objective: This cross-sectional investigation aimed to determine the incidence, clinical characteristics, prognosis, and related risk factors of olfactory and gustatory dysfunctions related to infection with the SARS-CoV-2 Omicron strain in mainland China. Methods: Data of patients with SARS-CoV-2 from December 28, 2022, to February 21, 2023, were collected through online and offline questionnaires from 45 tertiary hospitals and one center for disease control and prevention in mainland China. The questionnaire included demographic information, previous health history, smoking and alcohol drinking, SARS-CoV-2 vaccination, olfactory and gustatory function before and after infection, other symptoms after infection, as well as the duration and improvement of olfactory and gustatory dysfunction. The self-reported olfactory and gustatory functions of patients were evaluated using the Olfactory VAS scale and Gustatory VAS scale. Results: A total of 35 566 valid questionnaires were obtained, revealing a high incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain (67.75%). Females(χ2=367.013, P<0.001) and young people(χ2=120.210, P<0.001) were more likely to develop these dysfunctions. Gender(OR=1.564, 95%CI: 1.487-1.645), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), oral health status (OR=0.881, 95%CI: 0.839-0.926), smoking history (OR=1.152, 95%CI=1.080-1.229), and drinking history (OR=0.854, 95%CI: 0.785-0.928) were correlated with the occurrence of olfactory and taste dysfunctions related to SARS-CoV-2(above P<0.001). 44.62% (4 391/9 840) of the patients who had not recovered their sense of smell and taste also suffered from nasal congestion, runny nose, and 32.62% (3 210/9 840) suffered from dry mouth and sore throat. The improvement of olfactory and taste functions was correlated with the persistence of accompanying symptoms(χ2=10.873, P=0.001). The average score of olfactory and taste VAS scale was 8.41 and 8.51 respectively before SARS-CoV-2 infection, but decreased to3.69 and 4.29 respectively after SARS-CoV-2 infection, and recovered to 5.83and 6.55 respectively at the time of the survey. The median duration of olfactory and gustatory dysfunctions was 15 days and 12 days, respectively, with 0.5% (121/24 096) of patients experiencing these dysfunctions for more than 28 days. The overall self-reported improvement rate of smell and taste dysfunctions was 59.16% (14 256/24 096). Gender(OR=0.893, 95%CI: 0.839-0.951), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), history of head and facial trauma(OR=1.180, 95%CI: 1.036-1.344, P=0.013), nose (OR=1.104, 95%CI: 1.042-1.171, P=0.001) and oral (OR=1.162, 95%CI: 1.096-1.233) health status, smoking history(OR=0.765, 95%CI: 0.709-0.825), and the persistence of accompanying symptoms (OR=0.359, 95%CI: 0.332-0.388) were correlated with the recovery of olfactory and taste dysfunctions related to SARS-CoV-2 (above P<0.001 except for the indicated values). Conclusion: The incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain is high in mainland China, with females and young people more likely to develop these dysfunctions. Active and effective intervention measures may be required for cases that persist for a long time. The recovery of olfactory and taste functions is influenced by several factors, including gender, SARS-CoV-2 vaccination status, history of head and facial trauma, nasal and oral health status, smoking history, and persistence of accompanying symptoms.

Bioinformatics analysis of nasal epithelial cell gene expression in seasonal and perennial allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

Objective: Transcriptome sequencing and bioinformatics analysis were performed on the gene expression of nasal epithelial cells in patients with seasonal allergic rhinitis (AR) and perennial AR, so as to obtain the differences in the gene expression of nasal epithelial cells between seasonal AR and perennial AR. Methods: The human nasal epithelial cell line(HNEpC) was cultured in vitro, treated with 100 μg/ml mugwort or house dust mite (HDM) extracts for 24 hours. Total cell RNA was extracted, and quantitative real-time polymerase chain reaction (qPCR) was used to detect the expression of cytokines, including IL-6, IL-8, IL-33 and thymic stromal lymphopoietin (TSLP). From November 2019 to November 2020, 3 seasonal AR patients, 3 perennial AR patients, and 3 healthy controls who attended the Department of Otolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University were analyzed. The patients' primary nasal epithelial cells were cultured in vitro, treated with corresponding allergens for 24 hours. Total RNA was extracted for transcriptome sequencing, and the sequencing results were analyzed by bioinformatics. Results: The qPCR results showed that the cytokines IL-6, IL-8, IL-33 and TSLP of HNEpC treated with mugworts extracts and HDM extracts had the same trend of change. After the nasal epithelial cells from patients with seasonal AR and perennial AR were treated with corresponding allergens, there were differences in biological processes and signal pathways between those and control. Gene ontology (GO) enrichment analysis showed that the differentially expressed genes (DEG) in AR patients allergic to mugwort were mainly enriched in the oxidation-reduction process, the negative regulation of apoptosis process, and the cell adhesion; the DEG in AR patients allergic to HDM were mainly enriched in cell adhesion, the negative regulation of cell proliferation and the response to drug. Enrichment analysis of Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway showed that the DEG of AR patients allergic to mugwort were significantly enriched in arachidonic acid metabolism, p53 signaling pathway and transforming growth factor β (TGF-β) signaling pathway, while the DEG of AR patients allergic to HDM were mainly enriched in cells cycle, Fanconi anemia pathway and DNA replication. Gene Set Enrichment Analysis (GSEA) showed that the inflammatory response, TNF-α/NF-κB signaling pathway and IL-2/STAT5 signaling pathway were significantly up-regulated in AR patients allergic to mugwort, indicating the promotion of inflammatory response; and AR patients allergic to HDM had significant down-regulation of G2M, E2F, and MYC, indicating the inhibition of cell proliferation. The protein-protein interaction network showed that TNF and CDK1 were the most interacting proteins in mugwort and HDM allergic AR patients, respectively. Conclusion: Seasonal AR and perennial AR may affect the different biological processes and signal pathways of nasal epithelial cells, leading to differences in the occurrence and development of AR.

Hypoxic stimulation leads to the changes of inflammatory factors in mucosal epithelial cells of nasal polyps / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the roles of hypoxic stimulation in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) by comparing the variation and differences of inflammatory factors secreted from epithelial cells of nasal polyps and normal nasal mucosa under hypoxic stimulation. Methods: Sixty-eight patients who were diagnosed with CRSwNP from June 2015 to January 2018 at China-Japan Union Hospital of Jilin University were analyzed, including 36 males and 32 females, aged (45.2±12.5) years. Nasal polyps mucosa was included in CRS-NP group and inferior turbinate mucosa was included in CRS-IT group. According to the degree of eosinophil infiltration in histopathologic results, each of these two groups was further divided into eosinophil infiltration and non-eosinophil infiltration as Eos-NP group (n=34), Non-Eos-NP group (n=34), Eos-IT group (n=20) and Non-Eos-IT group (n=20). The inferior turbinate mucosa of twenty-five patients who were diagnosed with cyst of paranasal sinus or deviation of nasal septum was classified as control group (n=25), including 14 males and 11 females, aged (42.8±10.2) years. The expression of interleukin 17A (IL-17A), interferon γ (IFN-γ), tumor necrosis factor α (TNF-α) and hypoxia-inducible factor 1α (HIF-1α) in each group was analyzed by immunohistochemical staining. After 0, 24 and 48 h hypoxic stimulation, the secretion of IL-17A, IFN-γ, TNF-α in primary nasal mucosa epithelial cells of each group was tested by enzyme-linked immune sorbent assay (ELISA) experiment; the expression of HIF-1α was tested by immunofluorescent staining and imaging and Western blot. SPSS 17.0 software and two-way ANOVA were used for statistical analysis. Results: Immunohistochemical staining showed that the expression of IL-17A and TNF-α was much higher in control group (optical density (OD) value was 0.37±0.03, 0.53±0.02, respectively) and the expression of IFN-γ and HIF-1α was much higher in Eos-IT group (OD value was 0.47±0.03, 0.39±0.02, respectively). The secretion of IL-17A and TNF-α was much lower in control group than that in other groups under normal condition. After 48 h hypoxic stimulation, the secretion of IL-17A and TNF-α was much higher in control group compared with other groups. The secretion of IFN-γ in Eos-NP group was much higher than that in control group under normal condition ((13.7±1.3) pg/ml vs (11.1±1.6) pg/ml, P<0.05). After 48 h hypoxic stimulation, there was no difference of IFN-γ between control group and Eos-NP group. The expression of HIF-1α decreased in Eos-NP group and Non-Eos-NP group while increased in CRS-IT group and control group upon prolonged exposure to hypoxia. HIF-1α was mostly located at cytoplasm of epithelial cells in control and CRS-IT group while mainly located at nucleus of epithelial cells in CRS-NP group. Conclusions: The secretion of IL-17A, TNF-α, IFN-γ and the expression of HIF-1α show significant difference between normal nasal mucosa, polyps and inferior turbinate of CRSwNP under hypoxic stimulation, presenting different subcellular localization. This illustrates the proteins above are involved in transcription and regulation of the gene responsible for the pathogenesis of CRSwNP.

An investigation and intervention study on knowledge, attitude and behavior of ionizing radiation of elementary health care staff / 中国医学装备

Objective: To explore the effect of propaganda and training intervention about the ionization radiation knowledge for the cognition of these knowledge of elementary health care staff.Methods: A questionnaire survey about ionizing radiation knowledge was conducted on 181 medical workers in 10 township health hospitals in Xi'an.The contents of questionnaire included 5 parts that were basic knowledge,clinical application,daily protection,radiation hazard and emergency treatment.The Likert 3 grade scoring method was used to score the situation.And the training about ionizing radiation knowledge of protection was implemented for medical staff.The second questionnaires and scores were conducted after the intervention.And then the results of questionnaire survey and score between pre and post training were compared.Results: Before the training intervention,the average score of overall cognitive level of the ionizing radiation knowledge was(28.09±13.17),and the average score was increased to(49.79±10.35)after the training intervention.The difference of the number of three score segments(51-60,41-50 and 31-40)about the overall cognition of ionization radiation knowledge between pre and post interventions of propaganda and training were significant(x2=119.795,P＜0.05).The differences of clinical application score and basic knowledge between pre and post interventions of propaganda and training were no significant.And the scores of daily protection,radiation hazard and emergency treatment were increased to(11.39±0.35),(10.62±0.78)and(8.65±1.22)respectively,and the differences of them between pre and post interventions of propaganda and training were significant(t=2.18,t=1.87,t=1.56,P＜0.05),respectively.Conclusion: The cognitive interventions measurement of propaganda and training about preventive knowledge of ionization radiation can significantly improve the preventive awareness of elementary health care staff for ionizing radiation,and has a certainly promotion for enhancing the awareness and behavior of daily protection.

Overexpression of interleukin-l7 in tumor-associated macrophages is correlated with the differentiation and angiogenesis of laryngeal squamous cell carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Interleukin-l7 (IL-17), which exerts strong pro-inflammatory effects, has emerged as an important mediator in inflammation-associated cancer. The aim of this study was to clarify the relationship between IL-17 and tumor associated macrophages (TAMs), and the correlation of the microvessel density in the development of laryngeal squamous cell carcinoma (LSCC).</p><p><b>METHODS</b>Histopathological observations and immunohistochemistry staining for IL-17, CD68, and CD34 were performed on 72 specimens (32 cases of LSCC, 20 cases of adjacent tissues of carcinoma as controls, and 20 cases of chronic hypertrophic laryngitis). Double immunohistochemical staining was done to determine which cells expressed IL-17. Real-time quantitative PCR determined the mRNA expression of IL-17. ELISA was used to detect the expression of the serum level of IL-17 in the three groups.</p><p><b>RESULTS</b>The inflammation response had increased in LSCC. Overexpression of IL-17 and CD68 protein were seen in LSCC (P < 0.01). The expression of IL-17 was different between well and poorly differentiated LSCC (P < 0.01). The IL-17 expressing cells were mainly located in macrophages (CD68(+)/IL17(+)) as demonstrated by double immunohistochemical staining. IL-17 expression significantly correlated with high microvessel density (CD34(+)) in LSCC (P < 0.05). Relatively higher mRNA expression levels of IL-17 were seen in LSCC compared to the controls (P < 0.05). The serum expression of IL-17 was similar among the three groups (P > 0.05).</p><p><b>CONCLUSION</b>IL-17 was expressed by TAMs, and IL-17 may significantly correlate to the differentiation and angiogenesis in the development of LSCC.</p>

Efficacy and safety analysis with standardized mite allergen subcutaneous immunotherapy in 90 patients with allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the three-year efficacy and safety with standardized dust mite subcutaneous immunotherapy in patients with allergic rhinitis.</p><p><b>METHODS</b>Ninety patients who were diagnosed as allergic to mite by skin prick test and serum IgE were include in the standardized allergen-specific dose-escalation regimen. Nasal symptom score (0-3) were collected before treatment and three years after treatment; VAS (visual analogue scale, 0-10) of all nasal symptoms and drug use score were collected every four months; frequency of local and systemic reactions were recorded in the duration of dose escalation and maintenance.</p><p><b>RESULTS</b>Nasal blocking, sneeze, rhinorrhea and nasal itch were significantly improved after 3 years treatment (before treatment: 2[2;3], 2[2;3], 2[2;3], 2[1;2] ; after treatment: all were 0[0;0]; Z value were -8.310, -8.408, -8.377, -8.287, all P were 0.000). VAS of all nasal symptoms and drug use score decreased dramatically after escalation period (before treatment: 8.00[7.00;8.85], 2.00[1.50;2.00]; after treatment: 1.00[1.00;1.50], 0 [0;0]; Z value were -8.287, -8.248, P value 0.086, 0.744), and maintained afterwards (F value were 2.483, 0.296; P value were 0.086, 0.744). Ninety-eight case times (64.47%) local reactions mainly happened in maintenance period; the frequency of systemic reactions was 2.54%.</p><p><b>CONCLUSION</b>The standardized specific allergen immunotherapy for allergic rhinitis is safe and effective.</p>

Analysis of the level and significance of immunoglobulin free light chain in nasal secretion and in serum of patients with allergic rhinitis and non-allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To test the immunoglobulin free light chain (FLC) from nasal secretion(s) and serum of patients with allergic rhinitis and non-allergic rhinitis for the purpose of exploring the possible immunological mechanism.</p><p><b>METHODS</b>Sixty consecutive patients were selected between September and December in 2009, involving 30 patients with allergic rhinitis and 30 patients with non-allergic rhinitis, diagnosed by symptoms, signs, SPT and sIgE. Thirty volunteers was chosen as health control (HC). ELISA was used to detect the total IgE, eosinophil cationic protein (ECP), mast cell tryptase (MCT), κFLC, λFLC in nasal secretion and serum. The data was statistically analyzed by SPSS 17.0 software.</p><p><b>RESULTS</b>According to the VAS scores, the nasal symptoms of AR and NAR, including sneeze, nasal discharge, nasal obstruction and nasal itching were compared. There was no statistical difference (t value was 1.189, 0.741, 0.758, 0.797, respectively, P < 0.5); In serum, κFLC, λFLC, IgE, ECP & MCT were increased in NAR compared to HC (P < 0.05); λFLC was increased in NAR compared to AR group (P < 0.05), κFLC and ECP were increased in AR. There was no significant difference between AR and NAR (P < 0.05); In nasal secretion, κFLC, λFLC, IgE, ECP and MCT were increased in AR and NAR compared to HC, and the ECP and IgE were significantly increased in AR compared to NAR (P < 0.05). ; In nasal secretion, the FLCs revealed a significantly higher correlation with MCT (r value was 0.518 and 0.484, P < 0.01), and in serum revealed a significant correlation with ECP (r value was 0.343 and 0.342, P < 0.01).</p><p><b>CONCLUSIONS</b>Immunoglobulin free light chain takes part in the path of physiological process of allergic rhinitis and non-allergic rhinitis with the immunological mechanism.</p>

Survey on clinical characteristics of pediatric allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical symptom, precipitating factor, associated symptom, family history and life quality of pediatric patients with allergic rhinitis, and to analyze the characteristic of clinical symptoms.</p><p><b>METHODS</b>A questionnaire survey on pediatric AR patients since June 2008 to June 2010, one hundred and forty-eight pediatric AR patients were divided into 2 groups, group A (n = 43) included children aged from 3.2 to 6.0, group B (n = 105) included children aged from 6.1 to 14.8. The severity degree of clinical symptom was assessed by visual analogue scale.</p><p><b>RESULTS</b>Preschool age children had more severe rhinocleisis, more severe cough and less rhinorrhea than school age children (χ(2) value were 29.194, 12.277 and 16.904, respectively, P < 0.05). According to the classification criteria of ARIA 2008, preschool children had more mild intermittent AR and less moderate-severe persistent AR than school age children (χ(2) value were 20.370 and 24.546, P < 0.05). The precipitating factor of common cold, fitment, climate, environment factors were 22.3% (33/148), 5.4% (8/148), 16.2% (24/148), 3.4% (5/148), the others was 4.7% (7/148), no obvious precipitating factor was 48.0% (71/148). The rate of parent or parents who had allergic disease history was 11.5% (17/148). Quality of sleep that 66.2% (98/148) were upset and 62.2% (92/148) had no cathexis.</p><p><b>CONCLUSIONS</b>The preschool children have different clinical symptom characteristic from the school age children, and we got some clinical data of pediatric AR patients, those were beneficial to the diagnose and therapy of pediatric AR. The clinical data obtained in this study from pediatric AR patients are beneficial to the diagnosis and therapy of pediatric AR.</p>

Clinical features of non-allergic rhinitis and the therapeutic efficacy of combination of intranasal steroid and H1-antihistamine / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the basic clinical features of non-allergic rhinitis (NAR) in age, sex, incentives, and the effect of treatment with combined intranasal steroids and antihistamines.</p><p><b>METHODS</b>One hundred consecutive NAR patients were included in this study and the age, gender, predisposing factors and clinical symptoms were analyzed. Combined intranasal steroids and antihistamines used for 8 weeks, the symptoms were recorded before and after treatment with visual analogue scale(VAS) score as the assessment of treatment effects. SPSS 17.0 software was used to analyze the data.</p><p><b>RESULTS</b>Ninety-three NAR patients were adults, and the sex ratio was 1:1.2 (male:female), and the peak age incidence was between 30 - 39 years old. The main nasal symptoms were sneezing (96 cases), rhinorrhea (88 cases), nasal blockage (72 cases) and nasal itching (69 cases). The symptoms of eye and respiratory tract were always accompanied as eye itching (49 cases), tears (32 cases), congestion (22 cases), swelling (13 cases), cough (21 cases), suffocation (19 cases), chest compression (13 cases), wheezing (10 cases); Seventy-nine (79.0%) patients could indicate at least one kind of incentives, the temperature change (54 cases), dust (28 cases), irritating odor (21 cases) was the main incentive of NAR. Forty-seven patients completed the combined treatment of intranasal steroids and antihistamines, 38 (80.9%) patients were satisfied with the result with all symptoms relieved except wheezing (P < 0.05), but 36 patients had the NAR returned when they were exposed with the predisposing factors in the coming year; the remaining 9 (19.1%) patients failed the treatment.</p><p><b>CONCLUSIONS</b>The clinical features of NAR were as follows: adult constituted the main patient population, women were slightly more than man but with no difference between genders; sneezing and nasal discharge were the main clinical symptoms, always more than 1 incentives. The combination of intranasal steroids and antihistamines could control the most of clinical symptoms.</p>

Intranasal pretreatment with toll like receptor 9 ligand CpG oligodeoxynucleotides prevents the development of allergic rhinitis in juvenile guinea pigs / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of intranasal oligodeoxynucleotides with CpG motifs (CpG ODN) in prevention of allergic rhinitis in juvenile guinea pigs.</p><p><b>METHODS</b>Juvenile guinea pigs aged from 7 to 10 weeks were administrated with CpG ODN alone or combined with OVA at single dose concentration intranasally (on day 0, 5, 10, 15 in sequence) while control and blank group were administrated with saline. Both experimental and control animals were again sensitized by OVA (on day 18, 25), and 14 days after second sensitization animals were challenged by OVA intranasally (on days 39 and 46). Two hours after challenge, the animals were sacrificed. Then Hemotoxin and Eosin stain were carried out to analyze local eosinophilic reactions and nasal lesions. Local and systemic cytokines interleukin IL-5 and IFN-γ levels were examined by ELISA. Immunofluorescence was carried out with ICAM-1 antibody. Statistical analysis was performed using a SPSS 11.0 software.</p><p><b>RESULTS</b>In CpG ODN-administration or CpG ODN with OVA-administration group allergic rhinitis symptoms were not as severe as model control group (P < 0.05). Compared with the model control group, CpG ODN-administration did not increase production of OVA-specific Th1 cytokine IFN-γ but decreased productions of ovalbumin-specific Th2 cytokines IL-5 both in serum and nasal specimen (q value were 3.890 and 4.019, P < 0.05). Moreover, nasal lesions with infiltration of mean (x ± s) eosinophils (20.0 ± 9.6) in CpG group animal were prominently reduced by the CpG ODN-treatment compared with the control animals (53.5 ± 19.8) and CpG+OVA group (9.5 ± 5.7) were lower than CpG-M+OVA group (49.2 ± 18.9), the differences were significant (q value were 3.785 and 4.576, P < 0.05). Immunofluorescence results showed lower ICAM-1 expression in nasal specimen of CpG group compared with model group and CpG plus OVA group animal to CpG mimics plus OVA group (Z value were 3.697 and 3.765, P < 0.05).</p><p><b>CONCLUSIONS</b>Intranasal administration of CpG oligodeoxynucleotides with or without allergen may be an effective way to prevent the development of allergic rhinitis.</p>

Clinical characteristics in patients with non-allergic rhinitis and allergic rhinitis: preliminary analysis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare and analyze the clinical characteristics in patients with hyperreactive non-allergic rhinitis (HNAR) and allergic rhinitis (AR).</p><p><b>METHODS</b>A questionnaire survey on AR and HNAR patients between January and August 2009 was conducted. The clinical data of 298 AR patients and 100 HNAR patients were analyzed, including gender, age distribution, seasonal, clinical symptom and induced factors.</p><p><b>RESULTS</b>The number of male patients was more than female in AR, while in NAR, the number of female patients was more than male (χ(2) = 6.415, P = 0.01). The highest morbidity age in AR was teenagers, aged between 10 - 19 (χ(2) = 12.772, P = 0.00), while in HNAR, the highest morbidity age was middle-aged and youth, aged between 30 - 39 (χ(2) = 51.533, P = 0.00). The main onset seasons in AR was autumn, while there was no seasonal diversity in HNAR. The main allergen in AR was mugwort and ragweed, consistent with the vegetative cover characteristic in Jilin province. The main classification of AR was moderate-severe persistent (χ(2) = 123.991, P = 0.00), while the main classification of HNAR was moderate-severe intermittent (χ(2) = 97.420, P = 0.00). The clinical symptoms were significantly different between AR and HNAR except rhinocnesmus (all P < 0.05). There was consistency about non-specificity induced factors in AR and HNAR (all P > 0.05).</p><p><b>CONCLUSIONS</b>There were significant differences between AR and HNAR in sex, age, classification and seasons. The severity of clinical symptoms in AR was higher than that in HNAR except sneezing and gasping. There was consistency about induced factors in AR and HNAR.</p>

Endoscopic surgery for 89 cases of nasal inverted papilloma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of endoscopic surgery for nasal inverted papilloma.</p><p><b>METHODS</b>The clinical data of 89 patients treated with endoscopic surgery in our department from May 2003 to May 2008 were retrospectively analysed. The clinical classification was assessed by preoperative endoscopy and CT or MRI. All cases were routinely followed up from 1 to 5 years.</p><p><b>RESULTS</b>The recurrence rates in group of endoscopic management and group of endoscopic plus Caldwell-Luc management were 12.5% and 11.8% respectively (chi(2) = 0.007, P > 0.05). The recurrence rates in group of grade I, grade II and group of grade III patients were 9.1% (5/55), 17.2% (5/29) and 20% (1/5) respectively (P > 0.05). The recurrence rate in the two times operation group (27.3%) was significantly higher than that in the one time group (7.5%, chi(2) = 4.311, P < 0.05). There were 70 lesions certified to be resected completely, six of these patients (8.6%) recurred. Nineteen lesions were certified to be resected uncompletely, five of these patients (26.3%) recurred. The difference was no significant (chi(2) = 2.860, P = 0.09).</p><p><b>CONCLUSIONS</b>The endoscopic surgery in nasal inverted papillomas was an effective method with minimally invasiveness, but it still had a high recurrence. The pathological examine of surgical margin could partially judge the prognosis.</p>

Correlation analysis of two serum specific IgE test systems and skin prick test in allergic rhinitis patients / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the correlation between two serum specific IgE and skin prick test (SPT) for the diagnosis of allergic rhinitis.</p><p><b>METHODS</b>Two hundred and sixteen patients were referred to the allergist for a suspected allergic rhinitis between June and October in 2009. Patients were classified as positive for inhalant allergy if they had a positive clinical history and a related positive SPT for the suspected inhalant allergen. Statistical analysis was performed using SPSS13.0 software.</p><p><b>RESULTS</b>One hundred and fifty-eight patients had a positive SPT, comparing with the SPT, the diagnostic indexes (accuracy, sensitivity, specificity) of the ImmunoCAP system and the AllergyScreen system were 0.810 and 0.819, 0.872 and 0.780, 0.741 and 0.862 respectively. The accuracy was similar between the two systems (χ(2) = 0.112, P > 0.05). The ImmunoCAP system had a higher sensitivity (χ(2) = 7.361, P < 0.05). The AllergyScreen system had a higher specificity (χ(2) = 10.222, P < 0.05).</p><p><b>CONCLUSIONS</b>This data supported the use of ImmunoCAP system and AllergyScreen system to identify potentially significant individual allergens in the diagnosis of allergic rhinitis. The ImmunoCAP system had a higher sensitivity. The AllergyScreen system had a higher specificity. The AllergyScreen system can be used as a complementary with the ImmunoCAP system.</p>

Thymic stromal lymphopoietin expression is increased in nasal epithelial cells of patients with mugwort pollen sensitive-seasonal allergic rhinitis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Excessive expression of thymic stromal lymphopoietin (TSLP) has been demonstrated in asthmatic airway epithelia and in nasal epithelia from animal models of allergic rhinitis (AR), but the evidence of expression of TSLP in nasal epithelial cells (NECs) of patients with AR is lacking. We aimed to investigate the expression of TSLP in NECs of patients with mugwort sensitive-seasonal AR and determine whether it is associated with severity of symptoms and the number of infiltrated eosinophils in nasal mucosa.</p><p><b>METHODS</b>NECs specimens were obtained by scraping with plastic curettes from the nasal inferior turbinates of patients with mugwort pollen sensitive-seasonal AR (n = 22) and nonallergic controls (n = 11) during last peak mugwort pollen season. The severity of nasal symptom was assessed using a Visual Analog Scale (VAS). In addition, serum mugwort pollen IgE levels were tested from each patient. In situ hybridization (ISH) was performed to test the messenger RNA (mRNA) of TSLP in the NECs. Furthermore, immunohistochemical staining (IHC) was scored to evaluate the expression of TSLP and eosinophil cell count was made by May-Grünwald/Giemsa staining. The correlation between expression of TSLP and all other parameters was analyzed in this study.</p><p><b>RESULTS</b>The mRNA level of TSLP was significantly increased in NECs of patients with AR compared with the nonallergic control group (P < 0.05). In addition, IHC results showed that expression of TSLP in NECs from patients with AR was up-regulated which was correlated with VAS score (r = 0.598; P < 0.05) and nasal eosinophils count (r = 0.702; P < 0.05), but it was unrelated with mugwort pollen specific IgE level.</p><p><b>CONCLUSIONS</b>These preliminary findings indicate a potential relationship between TSLP expression, severity of symptoms and nasal eosinophils count in pathogenesis of AR, but TSLP expression did not correlate with mugwort pollen specific IgE level. The elevated expression of TSLP might play a critical role in local atopical responses of AR. In the future, the TSLP has the potential to be one of the most important molecular markers for AR diagnoses and assessment.</p>

Effects of minimal persistent inflammation on nasal mucosa of experimental allergic rhinitis in guinea pigs / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To establish an animal model of minimal persistent inflammation (MPI) of allergic rhinitis in guinea pigs and to investigate the changes of nasal mucosa. The expression of transforming growth factor-beta1 (TGF-beta1) and matrix metalloproteinases-9 (MMP-9) were discussed.</p><p><b>METHODS</b>Thirty male Hartley guinea pigs were randomly divided into two groups: MPI model group and control group randomly, with fifteen animals in each group. Guinea pigs from MPI model group were sensitized intraperitoneally by injection of suspension of ovalbumin (OVA) and aluminum hydroxide in 0.9% physiological saline. Then, repeated local booster sensitization with low concentration of OVA suspension into the nasal cavity was performed to establish MPI models. Alcian blue-periodic acid-Schiff (AB-PAS) staining and Masson's trichrome (MT) staining were used to determine the number of goblet cells and collagen deposition within the basement membrane of epithelium. The expression and distribution of TGF-beta1 and MMP-9 in nasal mucosa were estimated by double immunofluorescence under a confocal laser scan microscopy system.</p><p><b>RESULTS</b>Compared with the control group, the increased goblet cells (t = 13.720, P < 0.05) in nasal epithelium together with the increased collagen fibrils (t = 4.542, P <0.05) within the basement membrane of epithelium were observed in the MPI model group. There was nearly no expression of TGF-beta1, in the control group and the expression of MMP-9 was only found in the epithelium cell. In contrast, there was significantly higher expression of TGF-beta1 and MMP-9 (t = 25.218, P <0.05) in nasal mucosa of MPI model group than that in control group. TGF-beta1 mainly expressed in the epithelium cell, the infiltrated inflammatory cell and extracellular matrix, while MMP-9 expressed in the epithelium cell and the infiltrated inflammatory cell.</p><p><b>CONCLUSIONS</b>Long time MPI in allergic rhinitis resulted in some changes of tissue remodeling in nasal mucosa. TGF-beta1 and MMP-9 may play an important role in disease progression.</p>

Role of aquaporin 1 in the migration of eosinophils from asthmatic guinea pigs / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the role of aquaporin 1 (AQP1) in the migration of eosinophils (EOS) and to determine if AQP-1 can be viewed as the chemotactic activity marker of EOS.</p><p><b>METHODS</b>Asthma model of guinea pigs were developed and EOS were purified from both peripheral blood and bronchoalveolar lavage fluid (BALF). The smears of EOS were studied by in situ hybridization for determining AQP1 mRNA and immunofluorescence under laser scanning confocal microscope for determining AQP1 protein.</p><p><b>RESULTS</b>AQP1 was found expressed in EOS both from peripheral blood and from BALF. Compared with the expression of AQP1 mRNA (mean grey value 109.200 +/- 5.756, x +/- s) and protein (average fluorescence intensity 279.926 +/- 11.293) in EOS from BALF, there was stronger expression of AQP1 mRNA (92.904 +/- 3.290) and protein (425.081 +/- 17.474) in EOS from peripheral blood. The difference both of AQP1 mRNA (t = 9.519, P < 0.05) and protein(t = 27.020, P < 0.05) were considered statistically significant respectively.</p><p><b>CONCLUSIONS</b>AQP1 plays a crucial role in EOS movement. It is possible that EOS produce more AQP1 protein to accelerate its migration to inflammatory tissues under allergic disease and EOS with AQP1 highly expressed are activated. AQP1 can be viewed as the chemotactic activity marker of EOS.</p>

Establishment and significance of the experimental minimal persistent inflammation models in allergic rhinitis guinea pigs / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To develop an animal model of minimal persistent inflammation (MPI) in allergic rhinitis guinea pigs and to investigate its significance.</p><p><b>METHODS</b>Sixty male Hartley guinea pigs were divided into four groups: group A (positive control group), B (MPI model group), C (negative group) and D (bland group) respectively, with fifteen animals in each group. Guinea pigs from group A, B and C were sensitized intraperitoneally by injection of suspension of ovalbumin (OVA) and aluminum hydroxide in 0.9% physiological saline. Then, repeated local booster sensitization with different concentration of OVA suspension (1% and 0.01%) or physiological saline into the nasal cavity of those guinea pigs were performed. For group D, physiological saline was used only. Symptoms (sneezing) of guinea pigs after antigen challenge were observed and the infiltration of eosinophils (EOS) together with the expression of intercellular adhesion molecule 1 (ICAM-1) in the nasal epithelial cells were also examined.</p><p><b>RESULTS</b>When challenged with 1% OVA, the sneezing number of guinea pigs in group B was increased markedly than that in group D (P < 0.05). However, there was no difference between group B, A and C (P > 0.05). When challenged with 0.01% OVA, the symptom of sneezing almost disappeared in group B just like that in group D and there was no difference between the two groups (P > 0.05). Besides, there was still more EOS infiltrated in the nasal mucosa of guinea pigs in group B than that in group D (P < 0.05). There was no expression of ICAM-1 in nasal epithelium of guinea pigs in group D, nevertheless, ICAM-1 was found mildly expressed in group B.</p><p><b>CONCLUSIONS</b>MPI models have been established successfully through long term challenge with lower density of OVA in the sensitized guinea pigs, which will provide us with a new method for further research in the mechanism and treatment of allergic rhinitis.</p>

Proinflammatory effects of Staphylococcus aureus enterotoxin B on human nasal epithelial cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of Staphylococcus aureus enterotoxin B (SEB) on proinflammatory cytokine/chemokine releases in primary human nasal epithelial cell (HNEC).</p><p><b>METHODS</b>Epithelial cells of nasal polyps (NP) and inferior turbinate (IT) were cultured without serum under stimulus of SEB 1, 10, 100 ng/ml, IL-1beta 20 ng/ml and SEB 10 ng/ml + dexamethasone 13 ng/ml for 12,24 and 48 h, respectively. The expression of IL-5 and Granulocyte-macrophage colony stimulating factor (GM-CSF) mRNA derived from epithelial cells was detected by in situ hybridization.</p><p><b>RESULTS</b>(1) The expression of IL-5 and GM-CSF mRNA was time and dose-dependent, and reached to a peak under SEB 10 ng/ml for 24 h (P < 0.05). The mRNA expressed more intensively in epithelial cells from NP than IT (P < 0.05). (2) The expression of IL-5 and GM-CSF mRNA increased less under the stimulus of IL-1beta than SEB 10 ng/ml (P < 0.05). (3) The mRNA level of IL-5 and GM-CSF decreased under the stimulus of SEB + dexamethasone 13 ng/m when compared with the stimulus of SEB 10 ng/ml (P < 0.05).</p><p><b>CONCLUSION</b>SEB showed proinflammatory effects on HNEC.</p>

Expression of monocyte chemotactic protein 1 and vascular endothelial growth factor in nasal polyps / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the relationship between the expression of monocyte chemotactic protein 1 (MCP-1) and vascular endothelial growth factor (VEGF) in nasal polyp (NP) tissues and the role of MCP-1 in the formation of nasal polyps.</p><p><b>METHODS</b>Forty nasal polyp tissues obtained from NP patients were used to detect the expression of MCP-1 and VEGF at the levels of protein and mRNA by immunohistochemical and in situ hybridization assay. Twenty-five inferior turbinate (IT) samples obtained from chronic rhinitis patients were used as control.</p><p><b>RESULTS</b>The expression of MCP-1 and VEGF was higher in NP tissue than in IT at protein and mRNA levels (P <0.01). The expression of these two cytokines was positively correlated(r = 0.871, P <0.05).</p><p><b>CONCLUSIONS</b>MCP-1 and VEGF were involved in the formation of nasal polyps.</p>

Effects of glucocorticoid on tissue remodeling of nasal mucosa of chronic rhinosinusitis with nasal polyposis after endoscopic surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of glucocorticoid on tissue remodeling of nasal mucosa from patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) after endoscopic surgery.</p><p><b>METHODS</b>Nasal mucosa obtained from 30 cases of CRSwNP during nasal endoscopic surgery were considered as preoperation group. These patients were equally divided into two groups after surgery, ie. glucocorticoid group and contrast group. Uncinate process mucosa samples from 6 patients during septoplasty were considered as normal control group. Epithelial damage and expressions of transforming growth factor-beta1 (TGF-beta1) and collagen III were studied by light microscopy and immunohistochemistry.</p><p><b>RESULTS</b>In nasal mucosa samples of preoperation group, epithelial damage showed 90% (27/30) of stage 3 and 10% (3/30) of stage 2; TGF-beta1 positive cells and collagen III positive basement membrane with more than 20 microm were seen in 87% (26/30) and 97% (29/30) of samples, respectively. No significant difference was observed in morphology of nasal mucosa and expressions of TGF-beta1 and collagen III between glucocorticoid group and contrast group at 1th month after surgery. At 3th month after surgery, epithelial damage displayed 53% (8/15) of stage 3, 33% (5/15) of stage 2 and 14% (2/15) of stage 1 in contrast group; however, 93% (14/15) of stage 0 and 7% (1/15) of stage 1 in glucocorticoid group. The difference of epithelial damage between two groups was significant (Uc = 4.481, P < 0.05). The amount of TGF-beta1 positive cell was markedly higher in contrast group than in glucocorticoid group (t = 2.32, P < 0.05). The thickness of basement membrane was above 20 microm in 67% of contrast group (10 cases) and 27% of glucocorticoid group (4 cases); the difference between the two groups was significant (P < 0.05).</p><p><b>CONCLUSIONS</b>Tissue remodeling is present in nasal mucosa of CRSwNP after endoscopic surgery. Early and appropriate administration of glucocorticoid plays an important role in inhibition of tissue remodeling and prevention of relapse. Postoperative follow-up should not be less than 3 month.</p>