Research Method for Numerical Simulation on Upper Respiratory Tract Airway State Based on 3D Printing and CT Reconstruction / 医用生物力学

Objective To establish a comprehensive method combining physical model experiment and numerical simulation for studying airflow state of upper respiratory tract. Methods Based on CT medical images published online, a three-dimensional (3D) model of human upper respiratory tract was reconstructed. Based on 3D printing technology, an experimental model of the upper respiratory tract was established and the flow process of respiration was measured. A numerical simulation model was created based on the meshing of upper respiratory tract model and the turbulent Realizable k-ε model. Results Firstly, the result of numerical simulation was compared with the experimental conditions, and good agreement was achieved. The numerical simulation results showed that the airflow in respiratory process was in a parabolic shape; the distribution of flow field, pressure on wall and vortex structure were different between inspiratory and expiratory phases; there were air residues in the upper and lower nasal passages during the respiratory exchange process. In addition, the effects of airflow on physiological environment of the upper respiratory tract were preliminarily analyzed through the steak line, pressure field and vortex structure distribution. Conclusions The method proposed in this paper has the characteristics of pertinence, rapidity and accuracy, which gives full play to the advantages of reliable physical experiments and fine numerical simulation, and is applicable for studying different problems of the upper respiratory tract in different cases, with a high value for personalized diagnosis and treatment in clinic.

Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline for Chronic Rhinosinusitis

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines—with a focus on China—will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.

Study on the relationship between 11β-hydroxysteroid dehydrogenase and glucocorticoid response in nasal polyps / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the expression of 11β-hydroxysteroid dehydrogenase (11β-HSD) in polyps of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and its correlation with glucocorticoid sensitivity.@*Methods@#The prospective study method was applied. Forty-three adult CRSwNP patients from Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University between April 2016 and June 2017 were enrolled in this study. There were 19 males and 24 females with the age of (37.44±7.42) years old. The endoscopic scores by nasal Polyps Grading System before and after one-week prednisone treatment (0.5 mg/(kg·d)) were evaluated. The response of glucocorticoid by the total endoscopic scores was estimated. According to the patient′s reduced nasal polyp endoscopic score, patients were devided into nasal polyps insensitive to glucocorticoids treatment group (insensitive group) and nasal polyp sensitive to glucocorticoids treatment group (sensitive group). The expression of 11β-HSD1, 11β-HSD2 in nasal polyps were measured by Real-time PCR (RT-PCR), Western Blot and immunohistochemisty. According to the clinical data, the Logistic regression models and receiver operation characteristics (ROC) curves were used to explore the predictor for glucocorticoid response in CRSwNP.@*Results@#The expression of 11β-HSD1 and 11β-HSD1/11β-HSD2 was higher in sensitive group than that of insensitive group, while the expression of 11β-HSD2 was lower (rank average was 26.08 vs 16.33, 27.24 vs 14.72, 18.66 vs 26.64, Z value was -2.511, 0.323, -2.059, respectively, all P<0.05). The endoscopic scores in CRSwNP group declined whereas the expression of 11β-HSD1/11β-HSD2 increased (r=0.528, P=0.001), while the cutoff value of the ratio of 11β-HSD1/11β-HSD2 was 2.290 (sensitivity was 79.17%, specificity was 88.89%).@*Conclusions@#There is a positive correlation between the response of glucocorticoid and the ratio of 11β-HSD1/11β-HSD2, which could be used as a marker in predicting the level of tissue response to glucocorticoid therapy in CRSwNP.

The value of sinus computed tomography in predicting the response to oral glucocorticoids in chronic rhinosinusitis with nasal polyps / 中华耳鼻咽喉头颈外科杂志

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.

Principles of magnetic resonance imaging and its value in diagnosis of sinonasal disease / 中华耳鼻咽喉头颈外科杂志

Magnetic resonance imaging is commonly used in clinical work for its high resolution for soft tissue, and without radiation or interaction of bone interference. For ENT physicians, to read MRI accurately and retrieve more information from it would help the clinical work a lot. This review introduces the principles of MRI, the anatomy, the inflammatory disease, benign tumors and malignancies of the nasonasal tract.

Investigation of temporal and spatial characteristics of allergic rhinitis epidemics by Baidu Index in China / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the temporal and spatial characteristics of search volume (SV) of allergic rhinitis (AR) and related search terms on Baidu Index, as well as the correlation between SV from Baidu Index and epidemiology of AR.@*Methods@#SV of AR and related search terms in mainland area of China from January 2012 to December 2016 were extracted from Baidu Index. Firstly, we investigated the temporal and spatial characteristics of SV of AR and related search terms ("pollen allergy" and" dust mite allergy", etc.), and explored the correlation between SV of AR and SV of related search terms. Secondly, the SV of specific search terms in Beijing and Guangzhou were compared with the actual pollen count in Beijing from April to September in 2016 and the monthly outpatient volume of AR patients in the Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University from 2014 to 2016 respectively to analyze the consistency between SV from Baidu Index and the real-world data. Spearman correlation analysis was used to explore the correlation between different search terms according to the normality and homogeneity of variance of the data. P<0.05 was considered statistically significant.@*Results@#SV of AR showed repetitively seasonal pattern, with the first peak in May and the second peak from August to September. SV of AR in northeast China, north China and northwest China were correlated with both SV of "pollen allergy" and "dust mite allergy" (r value was 0.533, 0.638, 0.609, 0.791, 0.517, 0.682, respectively, all P<0.05). In east China, central China, south China and southwest China, SV of AR showed significant correlation only with SV of "dust mite allergy" (r value was 0.897, 0.884, 0.799, 0.937, respectively, all P<0.05), but not with SV of "pollen allergy" (r value was 0.110, 0.171, 0.020, 0.265, respectively, all P>0.05). The correlation between pollen count and the SV of AR on the day and SV of "pollen allergy" on the next day was the highest (r value was 0.692 and 0.713, respectively, all P<0.05). The SV of AR was correlated with the monthly outpatient volume of AR patients one month and two months later (r value was 0.523 and 0.503, respectively, all P<0.05).@*Conclusion@#The SV of AR and related search terms show different trends in different times and regions which are consistent with the AR epidemiological survey, and significantly correlate with pollen count and AR outpatient volume.

Clinical features, diagnosis and treatment of silent sinus syndrome / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the clinical features, diagnostic methods and therapeutic strategy of silent sinus syndrome (SSS).@*Methods@#A retrospective study was made on eight SSS patients treated during 2013-2016 in Longgang ENT Hospital and Otorhinolaryngology Hospital of the First Affiliated Hospital of SUN Yat-sen University. The following clinical data, including demographic data, symptoms, history of trauma and surgery, signs, imaging examination, endoscopic surgery and postoperative outcomes, were analyzed to summarize the diagnosis and treatment experiences.@*Results@#Eight SSS patients showed the following clinical features: the proportions of both sexes and sinus sides were 4 to 4; seven cases (7/8) were adult, with an average of (48.1±11.8)y; seven cases (7/8) had long history of trauma or surgery, with an average of (17.9±10.5)y; seven cases (7/8) cannot recall the exact course of SSS; six cases (6/8) had no nasal symptoms; eight cases (8/8) had unilateral ocular discomforts; eight cases (8/8) had signs of unilateral enophthalmos (2-5 mm), accompanied with hypoglobus; and by CT and MRI scanning, eight cases (8/8) showed the unilateral maxillary sinus outlet obstruction, sinus full opacification, sinus wall bony rarefaction, sinus wall contraction, sinus volume loss, and the ipsilateral orbital floor bowing descent and orbital volume increase. After treated by endoscopic sinus surgery and followed-up for one year, four cases were cured, and the other four improved; no intra- or post-operative complications occurred; and no individual need a two-stage orbital plastic reconstruction.@*Conclusions@#SSS often develops in the unilateral maxillary sinus of adult patient with long history of trauma or surgery, but the nasal symptoms and signs are silent. Diagnostic for SSS depends on characteristic ocular sign and sinus CT imaging. Endoscopic sinus surgery helps to improve ocular and nasal signs and promote orbital self-reconstruction.

Endoscopic salvage treatment for optic neuropathy caused by sinonasal fibro-osseous lesions / 中华耳鼻咽喉头颈外科杂志

Objective@#To summarize the surgical techniques, benefits and limitations of transnasal endoscopic resection and optic nerve decompression for patients with optic neuropathy caused by fibro-osseous lesions.@*Methods@#Eight patients with optic neuropathy caused by fibro-osseous lesions who accepted endoscopic surgery of either resection of the lesion or decompression of optic nerve in Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University from 2007 to 2016 were retrospectively reviewed and followed until April, 2017. Analyses were performed on the pathology type, disease extent and disease duration, especially on the visual acuity and visual field changes before and after surgery.@*Results@#Eight patients (5 male and 3 female) were included in this study, with a median age of 12 years old (8-19 years old). The median disease duration was 12 months (1-72 months). The visual acuity (VA) of five patients (40 cm/FC, 0.2, 0.1, 0.2, 10 cm/FC, respectively) improved after surgery (0.1, 0.3, 1.2, 0.1, 0.6, respectively), and one patient had no change of VA after the surgery. Two patients (0.02, hand movement, before surgery) became deprived of light perception (VA=0) immediately after surgery. One patient complicated with intra orbital hemorrhage because of anterior artery injury. No complications of cerebral spinal fluid leak, intra-ocular muscle injury, intra-cranial hemorrhage or brain tissue injury occurred.@*Conclusion@#For the treatment of optic neuropathy caused by fibro-osseous lesions, transnasal endoscopic surgery might have a good outcome.

Chronic rhinosinusitis with bronchial asthma, what should we concern about? / 中华耳鼻咽喉头颈外科杂志

There is a strong association between chronic rhinosinusitis (CRS) and asthma. Approximately 10%-50% of CRS patients also have comorbid asthma. These patients are more likely to have severe CRS and asthma and higher recurrence rates after sinus surgery. Also there may be acute asthma attack during the perioperative period. Therefore, we should pay more attention to these patients. Assessment of the control level of asthma and pulmonary function should be performed preoperatively. And asthma needs to be fully managed in the perioperative period to avoid acute asthma attack. Extensive sinus surgery is recommended in these patients to reduce the inflammation load. Long-term medical treatment and regular follow-up are suggested to achieve well control of CRS and asthma.

A national investigation on the application of Chinese guideline for the diagnosis and treatment of chronic rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the application of Chinese guideline for the diagnosis and treatment of chronic rhinosinusitis (2008, Nanchang) on a national scale.</p><p><b>METHODS</b>The contents of the guideline and its relevant applied indicators were designed into an initial questionnaire and, after a pre-survey, revised into a formal questionnaire. Then a stratified sampling was selected out of otolaryngology practitioners in the different level hospitals across the country. After a uniform training, the investigators were sent to these different hospitals to conduct questionnaire survey by face to face interview with otolaryngology respondents. Based on the summarized data, statistical analyses on the awareness and practice status of the guideline, together with their influencing factors, were made. SPSS 16.0 software was used to analyze the data.</p><p><b>RESULTS</b>Issuing and withdrawing questionnaires were performed from December 2012 to June 2013 and 1 240 respondents in 350 hospitals from 30 different provinces, municipalities or autonomous regions were effectively investigated. An average awareness and practice rate of 48.7% and 40.8% upon the guideline was acquired, respectively. There was a significant correlation (r = 0.280, P = 0.000) between the two indicators. With linear regression, county-level hospitals, junior practitioners, non-rhino professionals were the risk factors of poor guideline adherence. In addition, respondents form western region showed lower awareness and practice rate than that of ones from central and eastern region.</p><p><b>CONCLUSION</b>The adherence on Chinese guideline for the diagnosis and treatment of chronic rhinosinusitis is nationally low, so popularization of activities should be urgently strengthened, especially in focus areas, focus hospitals, and focus groups.</p>

Why should rhinologic doctor pay attention to the lower respiratory tract of chronic rhinosinusitis patients? / 临床耳鼻咽喉头颈外科杂志

The purpose of this review is to explain the relationship between chronic rhinosinusitis (CRS) and lower respiratory tract inflammation, especially asthma and introduce the new advances in the treatment of CRS patient with asthma. We also introduce our treatment strategy for these patients, including surgery technique and perioperative management.

Dynamic changes of chest CT in adult patients with severe adenovirus pneumonia / 实用放射学杂志

Objective To explore the characteristics of chest multi-slice spiral CT and dynamic changes in adult patients with se-vere adenovirus pneumonia.Methods Clinical and CT data of 6 patients with severe pneumonia in an epidemic of the respiratory ade-novirus infection were retrospectively analyzed.The impact of hormone therapy was also studied.Results The first chest CT exami-nations in 6 patients were performed 2.22 ± 0.75 days after fever.CT showed segmental consolidation with ground-glass opacity (GGO)in one case,patchy consolidation with GGO in 3 cases,patchy interstitial changes in one case and small nodules in one case. The duration reaching the standards of severe pneumonia was 6.1 7 ± 0.37 days from the onset.During severe phase chest CT showed a range of lobar consolidation in one case,lobar in 2 cases,segmental in 2 cases or patchy in one case,consolidation with GGO in 5 cases.In all cases the lesions were commonly seen in the lower lobes of bilateral lungs.Multiple lobes were involved in 2 cases.After methylprednisolone treatment,no new lesion was showed but the early lesion was enlarged.During the first 2 to 4 days GGO absorbed completely in 6 cases,consolidation absorbed completely in one case and mostly in 5 cases.Conclusion Chest CT findings of severe adenovirus pneumonia in adult are single or multiple lobar or segmental consolidations with or without GGO which distribute mainly at lower lobes.

Expression and Regulation of Transcription Factor FoxA2 in Chronic Rhinosinusitis With and Without Nasal Polyps

PURPOSE: Chronic rhinosinusitis (CRS) is characterized by the excessive production of mucus. However, the molecular mechanism underlying mucin overproduction in CRS with or without nasal polyps (CRSwNP and CRSsNP, respectively) is poorly understood. This study was conducted to assess the importance of the transcription factor FoxA2 in mucin production and to investigate the targeting of FoxA2 as a potential therapeutic strategy for mucus hypersecretion in CRS patients. METHODS: We enrolled 15 CRSwNP patients, 15 CRSsNP patients, and 10 normal controls in this study. The expression levels of FoxA2, MUC5AC, and MUC5B in inflamed and healthy nasal tissues were examined via immunohistochemistry and quantitative reverse transcription-polymerase chain reaction, and the levels of several proinflammatory cytokines in nasal secretions were measured via FlowCytomix analysis. In addition, the expression of MUC5AC and FoxA2 was determined in polyp-derived epithelial cells and NCI-H292 cells after in vitro stimulation. RESULTS: FoxA2 was significantly down-regulated, and MUC5AC and MUC5B were significantly up-regulated in both the CRSwNP and CRSsNP patients compared to the controls (P<0.05), and the protein level of FoxA2 was negatively associated with the IL-6 level in the CRS patients (P<0.05). IL-6 significantly increased MUC5AC expression but inhibited FoxA2 expression in vitro (P<0.05). Transfection with a FoxA2 expression plasmid significantly decreased MUC5AC promoter activity (P<0.05) and inhibited IL-6-induced MUC5AC production (P<0.05). In addition, clarithromycin significantly alleviated IL-6-induced FoxA2 suppression and decreased MUC5AC expression in vitro (P<0.05). CONCLUSIONS: Our findings suggest that FoxA2 may be considered a therapeutic target for the modulation of mucus hypersecretion in CRS patients.

Clinical effect of clarithromycin therapy in patients with chronic rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of clarithromycin (CAM) treatment in adult Chinese patients suffering from chronic rhinosinusitis with nasal polyps (CRSwNP) or without nasal polyps (CRSsNP).</p><p><b>METHODS</b>A prospective, open and self-controlled clinical trial on patients with CRS was conducted. Fifty patients met inclusion criteria. Of 50 patients, there were 33 patients with CRSsNP and 17 patients with CRSwNP. CAM was administered at 250 mg/d and the duration of administration was 12 weeks. Outcome measures included assessments of visual analogue scale (VAS), the sino-nasal outcome test-20(SNOT-20), the medical outcomes study short-form 36 items(SF-36), Lund-Kennedy endoscopy score, and Lund-Mackay computed tomography score. Before starting the treatment, 2 months after treatment and at the end of treatment, each patient had to complete all the measures except Lund-Mackay computed tomography score, which was only conducted before and after treatment. In order to evaluate the safety of CAM, liver function and renal function in all patients were detected before and after treatment. SPSS 16.0 software was used to analyze the data.</p><p><b>RESULTS</b>Forty-five patients completed 3 months follow-up and 5 patients withdrew due to different reasons. The results were as follows: (1) Thirty-three patients with CRSsNP's VAS scores of four time point were 5.81 ± 1.69, 3.76 ± 1.94, 2.98 ± 1.95, 2.06 ± 2.13, respectively, there were statistically significant improvements in turn (t values were 5.910, 8.090, 8.932, all P < 0.05). Endoscopy score of four time point were 6.28 ± 1.28, 5.00 ± 1.67, 4.12 ± 1.76, 3.12 ± 2.19, respectively, there were statistically significant improvements in turn compared with before treatment (t values were 6.662, 9.161, 9.936, all P < 0.05). The CT scores before and after treatment were 10.33 ± 4.65 and 4.67 ± 4.59, respectively (t = 7.226, P = 0.000) . (2) Seventeen patients with CRSwNP's VAS scores of four time point were 6.07 ± 2.02, 4.87 ± 2.61, 4.06 ± 2.85, 4.08 ± 2.80, respectively, there were statistically significant improvements after 2 or 3 months (t values were 3.285, 3.468, both P < 0.05) except after one month (t = 1.846, P > 0.05). Endoscopy score of four time point were 10.65 ± 1.77, 9.35 ± 1.93, 8.65 ± 2.76, 8.47 ± 2.76, respectively, there were statistically significant improvements in turn(t values were 4.068, 4.863, 5.156, all P < 0.05). The CT scores before and after treatment were 13.82 ± 4.94 and 11.41 ± 5.12, respectively (t = 3.975, P = 0.001). (3) During the period of CAM treatment, 1 patient reported a tolerable headache and weakness and 1 patient had abdominal pain after two months treatment, all the symptoms disappeared while they were asked to stop the drug. Liver function and renal function were detected in 40 patients, the differences before and after treatment were not significant statistically.</p><p><b>CONCLUSIONS</b>Long-term, low-dose CAM treatment is effective in the treatment of CRSsNP and CRSwNP in Chinese patients. Meanwhile, the efficacy of CAM is more significant in polyp-free group compared with polyp group. Low does CAM therapy is safe, and the liver function and renal function does not worsen after 3 months treatment.</p>

Fully Automated Determination of Four Androgenic Hormones in Serum by Online Turbulent Flow Solid Phase Extraction Coupled with Liquid Chromatography-Tandem Mass Spectrometry / 分析化学

A novel method was developed for the direct analysis of testosterone, androstenedione, methyltestosterone and methenolone in serum samples by fully automated online turbulent flow solid phase extraction coupled with high performance liquid chromatography-tandem mass spectrometry. An aliquot of 50 μL serum sample was preconcentrated directly on a Turboflow SPE column after centrifugation. Turboflow SPE C18-P could be used to remove serum matrix effectively. The optimum loading flow rate and elution time were 4. 0 mL/min and 1. 0 min, respectively. The linearity ranges were from 1. 0 μg/L to 100. 0 μg/L for four target compounds. The method limits of detection ( LODs) were in the range of 0. 2-0. 3 μg/L. The relative standard deviations (RSDs) ranged from 2. 9% to 14. 1% (n=5). The time for one sample analysis including extraction, separation and determination was 32 min. The proposed method has been successfully applied for the analysis of serum samples.

Expression and regulation of tight junction protein Occludin in nasal polyps / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the possible role of tight junction protein Occludin in nasal polyps.</p><p><b>METHODS</b>The expression of Claudin-1, Occludin and ZO-1 in nasal polyps (n = 20) and healthy uncinate mucosa (n = 15) were examined using immunohistochemical staining, real-time quantitative polymerase chain reaction (PCR) and Western blot analysis. The regulatory effects of proinflammatory cytokines (IFN-γ, IL-13, IL-17, TGF-β, TGF-α) on the expression of Occludin in cultured human nasal epithelial cells were investigated.</p><p><b>RESULTS</b>The immunohistochemical results showed that Claudin-1, Occludin and ZO-1 were detected both in the nasal polyp group and the control group. The expression sites were the cell membrane and cytoplasm of nasal mucosa epithelial cells. The mean optical density of Claudin-1, Occludin and ZO-1 were 0.187 ± 0.076,0.172 ± 0.109 and 0.098 ± 0.035 respectively in the nasal polyp group and were significantly lower than those in the control group (0.312 ± 0.101, 0.220 ± 0.069 and 0.233 ± 0.093 respectively), the differences were significant (t = 9.345, t = 3.301, t = 13.323, all P < 0.01).RT-PCR results showed that the relative expression of Occludin mRNA was 0.000 117 ± 0.000 035 in the nasal polyp group and was significantly lower than that in the control group(0.000 464 ± 0.000 134), and the difference was significant (Z = -5.0, P < 0.01) . There was no statistically significant difference in the relative expression of Claudin-1 and ZO-1 mRNA between the nasal polyp group and the control group (P > 0.05) . After the cultured human nasal epithelial cells were stimulated by IL-13, IL-17, IFN-γ and other proinflammatory cytokines, the relative expression of Occludin mRNA was 0.631 ± 0.039, 0.581 ± 0.029 and 0.648 ± 0.040, respectively. Compared with the unstimulated control group, the differences were statistically significant (t = 16.299, 24.669 and 14.995 respectively, all P < 0.05).Western blot analyse showed that the relative grayscale in the above proinflammatory cytokines stimulation groups was 0.650 ± 0.061,0.482 ± 0.106 and 0.536 ± 0.109, respectively. Compared with the unstimulated control group, the differences were statistically significant (t = 9.880, 8.442 and 7.310 respectively, all P < 0.05).</p><p><b>CONCLUSIONS</b>The reduced expression of Occludin might be involved in the pathogenesis of nasal polyps.</p>

Kinetic expression of T-bet and GATA-3 genes in rat allergic rhinitis models / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate kinetic expression of genes T-bet and GATA-3 in blood mononuclear cells (BMCs) in allergic rhinitis rats model at different stages of development of allergic rhinitis.@*METHOD@#Twenty SD rats (including 10 male and 10 female) were divided into 2 groups, experimental group and control group, randomly, 10 rats for each group. Ten rats in experimental group were sensitized and intranasally challenged by OVA, aluminium hydroxide hydrate gel and Bordelella pertussis inactive microorganism suspension (B. pertussis) adjuvants, as allergic rhinitis models, Ten rats in control group were investigated using physiological saline only. BMCs were separated from 2 ml blood which was extracted from rat heart at the end of sensitization, 10- hour after the first challenge and 10-hour after the final challenge, respectively. RT-PCR was utilized to detect the expression of T-bet and GATA-3.@*RESULT@#At the end of sensitization, 10-hour after the first challenge and 10-hour after the final challenge, in experimental group, Relative quantitation of expression of T-bet was 0.404 +/- 0.187, 1.676 +/- 0.708, 0.503 +/- 0.514 and that of GATA-3 was 0.434 +/- 0.147, 0.600 +/- 0.480, 1.029 +/- 0.690, respectively. While, In control group, Relative quantitation of expression of T-bet was 0.487 +/- 0.212, 0.486 +/- 0.148, 0.495 +/- 0.103 and and its of GATA-3 was 0.596 +/- 0.249, 0.474 +/- 0.101, 0.550 +/- 0.119, respectively. At 10-hour after the first challenge, relative quantitation of expression of T-bet in experimental group was increased markedly and there was significant difference compared with contol group (t=4.18, P<0.01). In experimental group, The amount of expression of T-bet at 10-hour after first challenge was higher than it at 10-hour after the final challenge and there was markedly difference (t=5.14, P<0.01). The amount of expression of T-bet at 10-hour after first challenge was increased significantly compared with it at the end of sensitization (t= 5.27, P<0.01). while, the expression of GATA-3 at 10-hour after final challenge was markedly increased compared with it at the end of sensitization (t= 3.51, P<0.05) and was higher than it at 10-hour after first challenge (t=2.53, P<0.05). At 10-hour after final challenge, The amount of expression of GATA-3 in experimental group was significantly higher than it in control group (t=2.71, P<0.05). However, both the expression of GATA-3 and T-bet had not markedly changed in control group.@*CONCLUSION@#It is thought that the development of allergic rhinitis is a successive and sequencing kinetic course, and imbalance of expression of GATA-3 and T-bet may be genetic base on allergic rhinitis, both GATA-3 and T-bet were involved in allergic rhinitis only in different phase of development of allergic rhinitis.

Diagnosis of small round cell tumor of nasal sinus and bases of skull (a report of 123 cases) / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the features and diagnosis way of small round cell tumor of nasal sinus and bases of skull.@*METHOD@#A retrospective analysis of 123 case with small round cell tumor of nasal sinus and bases of skull were carried out in our hospital in past ten year. Clinical, histological, radiological and immunohistochemical characters of these cases were studied.@*RESULT@#All cases usually complained of nasal obstruction, headache, diplopia, nasal mucus with bleeding, vision or weight loss. Expansible or infiltrative lumps were found in nasal sinus or bases of skull in radiological examination. A lot of small round cells were found in these tumors in histological pathology. At least 5-6 cell, tissue or tumor markers were examined immunohistochemically in most of cases before the final diagnosis were made. In some cases over 20 markers were examined. Five cases were carried out transmission electron microscope examination, special features such as desmosome and myofilament were found.@*CONCLUSION@#Clinical symptom, physical signs and radiological finding can supply malignant evidences of these tumors. Histological examination can make certain that they are small round cell tumors, but final diagnosis is still hard to make only by these. Immunohistochemical examination of various markers can tell the original characters of the specimen tissues, it is the key for final diagnosis. Transmission electron microscope examination is another helpful way for diagnosis.

Expression of T-bet in nasopharyngeal associated lymphatic tissue of patients with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the pattern and value of the expression of T-bet in nasopharyngeal-associated lymphatic tissue (NALT) of patients with or without allergic rhinitis (AR).@*METHOD@#T-bet and CD4/T-bet expression in adenoids, tonsils and nasal mucosa was respectively detected with single stain and double stain of immunohistochemistry.@*RESULT@#The positive ratio of T-bet expression in tonsils, adenoids and nasal mucosa between AR group and the control group had statistically different (P < 0.05). There was statistical difference of T-bet expression in tonsils from AR group in three different age groups (P < 0.05). The difference was that T-bet expression in adults group was significantly lower than that in children group and adolescent group. There was no difference of T-bet expression among different age groups in non-AR group. There were some positive expression of CD4 and T-bet in tonsils, adenoids and nasal mucosa from two groups and most positive expression of T-bet on CD4 positive cell.@*CONCLUSION@#T-bet expression was down-regulated in NALT of patients with AR. T-bet expression of NALT is associated with allergic mucosal inflammation and functional status of NALT, as well as the weak Th1 response at the level of transfer factor in local mucosa of respiratory tract in AR patients.

The application, observation and discussion of indications about no packing after ESS / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the safety and feasibility after functional Endoscopic surgery(FESS), without no nasal packing in 74 patients,compare these patients with 20 packing patients, and discuss the possibility and indication of avoiding packing.@*METHOD@#No nasal packing after FESS in 74 patients, the measures had been taken to reduce postoperative bleeding including appropriate case-chosen, medical administration before and after operation, alleviation of trauma in operation, and meticulous sinus clearance to prevent synechia.@*RESULT@#The postoperative blood loss were less than 50 ml. No bleeding complication happened out of the 74 no-packing patients, the blood exudation ceased timely after FESS.@*CONCLUSION@#The nasal packing could be avoided in the majority of FESS through proper management. This choice will reduce the discomfort and the cost of the patients who have to receive FESS procedure, and increase their compliance.